Revision mcqs

In an experiment, cells are subjected to radiant energy in the form of x-rays. This results in
cell injury caused by hydrolysis of water. Which of the following ions is responsible for
damage of cells from this type of injury?
a. HOCL
b. Hypobromite
c. H2O2
d. Hydroxyl ion
e. Superoxide anion

What roles in regulating the intrinsic pathway of apoptosis are played by the Bcl-2 protein
family members Bax and Bcl-2?
a. Bax inhibits apoptosis while Bcl-2 stimulates apoptosis.
b. Bax stimulates apoptosis while Bcl-2 inhibits apoptosis.
c. Both Bax and Bcl-2 inhibit apoptosis.
d. Both Bax and Bcl-2 stimulate apoptosis.
e. Bax and Bcl2 have no role in apoptosis
Which of the following pathologic processes has most likely occurred in a pulmonary nodule
due to infection by Mycobacterial tuberculosis?
Caseous necrosis

Coagulative necrosis

Fat necrosis

Fatty change

Gangrenous necrosis

A 30-year-old man sustains a left femoral fracture in a skiing accident, and his leg is placed in a
plaster cast. After the leg has been immobilized for several weeks, the diameter of the left calf
has decreased. This change is most likely to result from which of the following alterations in the
calf muscles?
Aplasia

Hypoplasia

Atrophy

Dystrophy
 Hyalinosis

A 45 years old coal worker man has had a chronic cough for the past year. A chest radiograph
shows enlargement of hilar lymph nodes. Examination of the biopsied hilar lymph nodes reveal
a uniform, dark black cut surface. Which of the following pigment most likely accounts for the
appearance of the lymph nodes?
Melanin

Carbon

Hemosiderin

Lipofuscin

Amyloid

Inflammation (5)
A 5-year-old child reaches up to the stove and touches a pot of boiling soup. Within several
hours, there is marked erythema of the skin of the fingers on the child’s right hand, and small
blisters appear on the finger pads. Which of the following terms best describes this process?
Fibrinous inflammation

Purulent inflammation

Serous inflammation

Ulceration

Granulomatous inflammation
One month after an appendectomy, a 25-year-old woman palpates a small nodule beneath the
skin at the site of the healed right lower quadrant incision. The biopsy of the nodule shows
macrophages, collagen, a few small lymphocytes, and multinucleated giant cells. Which of the
following complications of the surgery best accounts for these findings?
Chronic inflammation

Abscess formation

Granuloma

Ulceration

Edema
A 5-year-old child reaches up to the stove and touches a pot of boiling soup. Within several
hours, there is marked erythema of the skin of the fingers on the child’s right hand, and small
blisters appear on the finger pads. Which of the following terms best describes this process?
Fibrinous inflammation

Purulent inflammation

Serous inflammation

Ulceration

Granulomatous inflammation
One month after an appendectomy, a 25-year-old woman palpates a small nodule beneath the
skin at the site of the healed right lower quadrant incision. The biopsy of the nodule shows
macrophages, collagen, a few small lymphocytes, and multinucleated giant cells. Which of the
following complications of the surgery best accounts for these findings?
Chronic inflammation

Abscess formation

Granuloma

Ulceration

Edema
A keloid is:
Exuberant granulation tissue
Excessive collagen accumulation
Scar due to burn of severe degree
Recurrent fibroblastic tumor
Exuberant proliferation of fibroblasts
Regarding antibody-mediated immunity and cell-mediated immunity,
which one of the following is the most accurate?
Antibody-mediated immunity helps prevent graft rejection.
Antibody-mediated immunity protects against anaphylactic shock.
Antibody-mediated immunity protects against autoimmune diseases.
Cell-mediated immunity neutralizes extracellular viruses.
Cell-mediated immunity protects against fungal infections.
Which one of the following induces an IgM antibody response without the participation of
helper T cells?
Diphtheria toxoid
Pneumococcal capsular polysaccharide
Pneumococcal polysaccharide conjugated to diphtheria toxoid
Tetanus toxoid
Toxic shock syndrome toxin
Which one of the five immunoglobulins is transferred from mother to fetus in utero
 IgA
IgE
IgD
IgM
IgG
Which one of the following sets of cells can present antigen to helper T cells?
B cells and dendritic cells
B cells and cytotoxic T cells
Macrophages and eosinophils
Neutrophils and cytotoxic T cells
Neutrophils and plasma cells

Regarding sterilization and disinfection, which one of the following is the most accurate
statement?
a. The temperature of autoclave must be 121 C to kill bacterial spores
b. Seventy percent alcohol is a better antiseptic than iodine
c. Disinfectants kill both bacterial cells and bacterial spores.
d. Pasteurization, which kills both bacterial cells and spores.
e. Ultraviolet light kills bacteria by causing oxidation of lipids in the cell membrane
Bacteria, fungi (yeasts and molds), viruses, and protozoa are important causes of human
disease. Which one of the following microbes contains either DNA or RNA but not both?
a. Bacteria
b. Molds
c. Protozoa
d. Viruses
e. Yeasts
Which one of the following contains DNA without a nuclear membrane?
a. Bacteria
b. Molds
c. Protozoa
d. Yeasts
e. Helminthes
The initial step in the process of many bacterial infections is adherence of the organism to
mucous membranes. The bacterial component that mediates adherence is the:
a. Lipid A
b. Nucleoid
c. Peptidoglycan
d. Pilus
e. Plasmid
Protection of the unimmunized individual based on immunization of a sufficient number of
other members of the population is a description of which one of the following?
Active immunity
Herd immunity
Passive immunity
Passive-active immunity
Post-exposure immunity

Which of the following organisms is acquired via entry of spores (present in the soil) in the
wound
Corynebacterium diphtheria
Escherichia coli
Streptococcus pneumonia
streptococcus pyogenes
Clostridium tetani
Patient presented with the history of diarrhea after consumption of contaminated meat. Which
one of the following is the causative organism?
Campylobacter jejuni
Coxiella burnetti
Francisella tularensis
Yersinia pestis
Rickettsia rickettsii

Basic viro (5)

Which one of the following viruses has DOUBLE stranded RNA
Reovirus
Hepatitis A virus
Herpes simplex virus
Poliovirus
Parvovirus B 19

Which one of the following hepatitis viruses has RNA as nucleic acid
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Adults who have had varicella as children occasionally suffer a recurrent form of the
disease, shingles. The agent causing these diseases is a member of which one of the
following viral families?
 Herpesvirus
Poxvirus
Adenovirus
Myxovirus
Paramyxovirus

Infectious prion protein (known as PrPsc)

has a significant amount of beta-helical conformation.
has a significant amount of alpha-helical conformation.
has a significant amount of gamma-helical conformation.
has a significant amount of alpha-pleated conformation.
has a significant amount of beta pleated conformation
If a virus has an envelope, it is more easily inactivated by lipid solvents and detergents than
viruses that do not have an envelope. Which one of the following viruses is the most
sensitive to inactivation by lipid solvents and detergents?
Coxsackie virus
Hepatitis A virus
Herpes simplex virus
Poliovirus
Rotavirus
Basic para
Which of the following parasite belongs to the class Nematoda
a. Plasmodium vivax
b. Tenia saginata
c. Tenia solium
d. Ascaris lumbricoides
e. Trypanosoma cruzi
Which of the following parasite belongs to the class Cestoda
a. Plasmodium vivax
b. Tenia saginata
c. Enterobius vermicularis
d. Ascaris lumbricoides
e. Leishmania tropica
Which of the following parasites has feco oral route of infection
a. Plasmodium falciparum
b. Leishmania donovani
c. Entamoeba histolytica
d. Trichomonas vaginalis
e. Trypanosoma cruzi
 The most common parasitic cause of watery diarrhea in AIDS patients is
a. Plasmodium vivax
b. Leishmania tropica
c. Giardia lamblia
d. Cryptosporidium parvum
e. Trypanosoma cruzi

A pharmaceutical company has developed a new compound that is well tolerated by the
body and inhibits the sterol ergosterol synthesis. Screening of anti-infectious agent
activity should be directed toward
Bacteria
Protozoa
Fungi
Helminths
Viruses
Overgrowth of which of the following organism in the mouth produces white patches called
thrush.
Streptococcus
Enterococcus
Actinomyces
Lactobacillus
Candida
A 27-year-old obese, white female with type 1 diabetes mellitus has a history of one month
fever. She has white patches on her tongue. On oral examination white peudomembranous
lesions were seen. What is expected to be seen under microscope
Gram-positive bacteria
Gram-negative bacteria
Hyphae with septa and acute angle branching
Spherules containing endospores
Yeast cells, hyphae, and pseudohyphae

Genetics
A clinical study is undertaken with subjects from families in which complications of
atherosclerotic cardiovascular disease and tendinous xanthomas occurred before age 30.
Some of the children in these families are observed to have early atheroma formation.
These affected individuals are most likely to have a mutation in a gene encoding a cell
surface receptor for which of the following?
Cortisol
Insulin
LDL cholesterol
 Leptin
TGF-α
A 22-year-old man has a sudden loss of vision in the right eye. On physical examination,
there is a subluxation of the crystalline lens of the right eye. An echocardiogram shows a
floppy mitral valve and dilated aortic arch. The patient’s brother and his cousin are similarly
affected. A genetic defect involving which of the following substances is most likely to be
present in this patient?
Dystrophin
Collagen
Fibrillin-1
NF1 protein
Spectrin

Which of the following chromosomal abnormalities is most likely to be present in the

somatic cells of a child having Down’s syndrome?
Haploidy
Monosomy
Mosaicism
Tetraploidy
Triploidy
Neoplasia
Which one of the following neoplasms is highly invasive but seldom spread by metastasis?
a. Papillomas of the skin
b. squamous cell carcinomas of the skin
c. adenocarcinomas of the lungs
d. basal cell carcinomas of the skin
e. osteogenic sarcomas of the limbs
A 5-year-old child has difficulty with vision in the right eye. On physical examination, there is
a mass in the right eye. The child undergoes enucleation of the right eye. Molecular analysis
of the neoplastic cells indicates absence of both copies of a tumor suppressor gene. Which
of the following genes is most likely to be involved?
BCR-ABL
BCL2
K-RAS
p53
RB

Which one of the following features is more characteristic of a benign than a malignant
neoplasm
a. grows by expansion and implantation occurs frequently
b. metastasizes if the brain is the site of origin
c. usually non-encapsulated and necrosis seldom occurs
d. tend to recur after surgical removal
e. usually occur singly and do not recur after surgical removal
Which one of the following is considered to be the hallmark of malignancy
a. anaplasia and the rate of growth of the neoplastic mass
b.metastasis and the degree of encapsulation of the neoplastic mass
c. formation of giant cells and cellular anaplasia within and around the neoplastic mass
d. presence of undifferentiated cells and evidence of metastasis
e. cellular anaplasia and growth by expansion of the neoplastic mass

A 62-year-old man with a history of chronic alcoholism has noted a 6-kg weight loss over the
past 5 months. Physical examination shows no masses or palpable lymphadenopathy.
Laboratory studies include an elevated serum α-fetoprotein level. A stool guaiac test result
is negative. Which of the following is the most likely diagnosis?
Prostatic adenocarcinoma
Pulmonary squamous cell carcinoma
Hepatocellular carcinoma
Pancreatic adenocarcinoma
Multiple myeloma

The most common paraneoplastic syndrome is:

Polycythemia
Neuropathy
Hypercalcemia
Clubbing
Adenoma

Hemodynamics
The breakage of long bones can result in
Fat embolism
Air embolism
Infective embolism
Thromboembolism
Infarction
Which one of the following is the cause of hypovolemic shock
a. Scurvy
b. Increased hydrostatic pressure
c. Gram negative bacteria
d. Fluid loss from burns
e. Gram positive rods
Patients with extensive endothelial injury from Escherichia coli sepsis have consumption of
coagulation factors as well as an extensive inflammatory response. Administration of
activated protein C decreases this inflammatory response by reducing the amount of a
 substance that normally binds to protease-activated receptors to trigger expression of
adhesion molecules, cytokines, and chemokines. What is this substance most likely to be?
Complement
Fibrin
Kallikrein
Plasmin
Thrombin
A 59-year-old obese woman with a history of diabetes mellitus had a myocardial infarction 3
months ago. She is now taking a low dose of aspirin to reduce the risk of arterial
thrombosis. On which of the following steps in hemostasis does aspirin have its greatest
effect?
Adhesion of platelets to collagen
Aggregation of platelets
Production of tissue factor
Synthesis of von Willebrand factor
Synthesis of antithrombin III

Hematology
ABO blood system is most important in clinical medicine because

It was the first blood group to be discovered

It has four different blood groups A, B, AB and O

ABO antigens are present in most body tissues and fluids

It is widely distributed blood group in most individuals

ABO antibodies are invariably present in plasma when persons lack the
corresponding antigen

Reticulocytosis is seen in

Iron deficiency anemia

Megaloblastic anemia

Haemolytic anemia

Aplastic anemia

Sideroblastic anemia
The Hyper segmented neutrophil is most likely to be found in association with

Folic acid deficiency

Infection

Iron deficiency

Malignancy

Ingestion of a marrow-toxic agent

Deletion of all four normal α-globin genes will most likely produce

α thalassemia minor

β thalassemia minor

Cooley’s anemia

Hemoglobin H disease

Hydrops fetalis

A single nucleotide change in a codon on chromosome 11 that causes valine to replace

glutamic acid at the sixth position of the β chain of hemoglobin is associated with

α thalassemia

Glucose-6-phosphate dehydrogenase deficiency

Hereditary spherocytosis

Paroxysmal nocturnal hemoglobinuria

Sickle cell anemia

Which of the following red cell abnormalities is most indicative of hemolysis?

Target cells

Acanthocytes

Schistocytes

Basophilic stippling

Macrocytes
An anemic patient is found to have hypochromic, microcytic red cells. Additional tests
reveal the serum iron levels, the total iron-binding capacity, and the transferrin saturation
to be reduced. A bone marrow biopsy reveals the iron to be present mainly within
macrophages. Which of the following is the most likely diagnosis?

Iron deficiency

Thalassemia trait

Anemia of chronic disease

Sideroblastic anemia

Pernicious anemia

Which of the following test is best in differentiating between anemia of chronic disease
(ACD) and Iron deficiency anemia (IDA)?

serum ferritin
serum transferrin
Total iron binding capacity
% transferrin saturation
Serum amylase

A 35 years old woman is seen for easy fatigue for many months. She delivered an
anamolous baby with neural tube defects. Most likely cause for such an anamoly is
Iron deficiency anemia
Anemia of chronic disease
Folic acid deficiency
Megaloblastic anemia
Microcytic anemia

A 59-year-old man with a history of coronary artery disease and severe mitral regurgitation
had surgery to replace his mitral valve. Six months after surgery he presented with
increasing fatigue. Workup finds a normocytic normochromic anemia that is due to
fragmentation of red blood cells by his artificial heart valve. Which of the following red cell
abnormalities is most indicative of intravascular hemolysis and is most likely seen in
peripheral blood smear?
Drepanocytes
Heinz bodies
Pappenheimer bodies
Schistocytes
koilocytes
Hemoglobin electrophoresis of the blood from an individual with β–thalassemia major
would most likely show which one of the following combinations of findings?

Hemoglobin A Hemoglobin A2 Hemoglobin F

Increased Increased Increased
Increased Increased Decreased
Increased Decreased Increased
Decreased Increased Increased
decreased decreased decreased
Hereditary spherocytosis is associated with abnormality of which of the following protein?
Ankyrin
Dystrophin
Fibrillin
Frataxin
Spectrin
Laboratory studies of 34 years old man show hemoglobin, 8.5 g/dL, platelet count
13,000/mm3 and WBC count, 52,100/mm3 with 5% segmented neutrophils, 5% bands, 2%
myelocytes, 83% blasts, 3% lymphocytes, and 2% monocytes. Examination of his peripheral
blood smear shows the blasts have delicate nuclear chromatin along with fine cytoplasmic
azurophilic granules. These blasts are CD33+. Which of the following morphologic findings is
most likely to be present on his peripheral blood smear?
Auer rods
 Döhle bodies
Hairy projections
Heinz bodies
psammoma bodies
Young female presented to OPD with complaints of menorrhagia. She also gave positive
family history of bleeding disorders. She is diagnosed as case of Von Wille Brand disease
(vWD)
Which lab findings do you expect?
Low platelet count, prolonged APTT
Prolonged APTT, low Von Wille brand Factor
Low platelet count, Normal APTT, low Von Wille brand Factor
Normal PT, Normal APTT, low Von Wille brand Factor
Normal PT, Normal APTT, normal Von Wille brand Factor

Lymphoid system
Most common age group for Acute Lymphoblastic leukemia (ALL) is
3-10 years
7-15 years
30- 40 years
40-60 years
80-90 years
Known case of Hodgkin Lymphoma with history of fever also has three lymph nodes on both
sides of diaphragm. According to Arbor staging system he has stage
Stage II
Stage IIB
Stage III
Stage IV
Stage VI
BCR-ABL1 fusion gene is distinctive of
Chronic Myeloid Leukemia
 Chronic Lymphoid Leukemia
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Acute Myeloid Leukemia

Which of the following parasites passes through the lung during human infection ?
Ascaris lumbricoides
Plasmodium falciparum
Teania solium
Giardia lamblia
Trichomonas vaginalis
Mycology
Which of the following fungi is responsible for cavitatory lung lesions after inhalation of its
spores
Coccidioides immites
Candida albicans
Cryptococcus neoformans
Paracoccidioides brasiliensis
Histoplasma capsulatum

Which one of the following parasites causes myocardial cell damage resulting in
Ascaris lumbricoides
Plasmodium falciparum
Teania solium
Trypanosoma cruzi
Trichomonas vaginalis
A 14 yr old male patient presented with a history of fever, painful swelling in his feet,
knees and right wrist 14 days after a throat infection. Patient also complained of
palpitation, chest pain and shortness of breath occasionally. What is the diagnosis
Meningitis
Post streptococcal glomerulonephritis
Pneumonia
Post streptococcal rheumatic fever
Tuberculosis
 Which one of the following best describes the pathogenesis of rheumatic fever?
An exotoxin produced by Streptococcus pyogenes that acts as a superantigen damages
cardiac muscle.
An exotoxin produced by Streptococcus pyogenes that ADP ribosylates a G protein damages
joint tissue.
Antibody to the capsular polysaccharide of Streptococcus pyogenes cross-reacts with joint
tissue and damages it.
Antibody to the M protein of Streptococcus pyogenes cross reacts with antigens of joint,
brain and cardiac muscle and damages it.
Endotoxin produced by Streptococcus pyogenes activates macrophages

6. Which one of the following best describes the pathogenesis of post streptococcal
rheumatic fever?
An exotoxin produced by Streptococcus pyogenes that acts as a superantigen damages
cardiac muscle.
An exotoxin produced by Streptococcus pyogenes that ADP ribosylates a G protein damages
joint tissue.
Antibody to the capsular polysaccharide of Streptococcus pyogenes cross-reacts with joint
tissue and damages it.
Antibody to the M protein of Streptococcus pyogenes cross reacts with antigens of joint,
brain and cardiac muscle and damages it.
Endotoxin produced by Streptococcus pyogenes activates macrophages
CVS (4micro)

A patient presented with a history of high- grade fever with chills and rigors, severe
headache and mayalgias after mosquito bite. Fever occurs after every third day
Which one of the following parasites is the causative organism?
Plasmodium vivax
Trypanosoma cruzii
Ascaris lumbricoides
Entamoeba histolytica
 Leishmania donovanii

A 24-year-old medical student was seen by her primary care physician because of sudden
onset of fever (104°F), chills, severe headache, pain around the eyeballs, muscle and severe
bone pain. O/E Maculopapular rash and enlarged LNs. Doctor was suspecting as a viral
infection, caused by a bite of mosquito.
Lab investigations: IgM antibodies to one of the flavi virus detected. What is the most likely
diagnosis?

Measles
Dengue fever
Malaria
Chickenpox
Rabies
A patient presented with intermittent fever, weakness, and weight loss with distension of
abdomen. On examination, massive enlargement of the spleen and Hyperpigmentation of the
skin was noted. There was prevalence of sand flies in that area. What is the diagnosis
Measles
Dengue hemorrhagic fever
Leishmaniasis
Black water fever
Trypanosomiasis

What is the site of infection in the case of visceral Leishmaniasis?

Macrophages
Neutrophils
Red blood cells
Eosinophils
basophils

Reproduction
In a case of urethritis in a 25 years old sexually active man, Chlamydia trachomatis was the
causative organism. Chlamydia is
An obligate extracellular bacteria
An obligate intracellular bacteria
Facultative Anaerobic Bacteria
Aerobic Bacteria
Microaerophilic Bacteria
A 34-year-old sexually active man was referred to a dermatologist for evaluation of a non-
pruritic skin rash. The rash had appeared on his abdomen 3 weeks earlier and, over 1 week,
had spread to his entire body, including his palm and soles. He also noticed a non- tender
ulcer on his external genitalia before the appearance of rash. He admitted to having
unprotected sexual contact with a new partner about 6 weeks before the onset of his lesions.
What is the diagnosis
Actinomycosis
Genital Herpes
Gonorrhea
Syphilis
Trichomoniasis
Which one of the following is the causative organism in non-gonococcal urethritis
Treponema pallidum
Chlamydia trachomatis
Neisseria gonorrhoeae
Staphylococcus aureus
Trichomonas vaginalis

A 45 years old man presented with the complaints of yellowish colored discharge from
urethra, dysuria and urethral discomfort. Gonococcal urethritis is diagnosed. What is the route
of transmission of causative organism in this case.
Feco-oral
Sexual interaction
Inhalation
Through blood transfusion
Through dental procedures
In Tuberculosis, the secondary lesion appears mostly in the apices of lung due to
Increase concentration of oxygen
decrease concentration of oxygen
anaerobic conditions
microaerophilic condition
increase CO2 concentration

Which one of the following statement describes the Reactivation of tuberculosis:

Decrease cell mediated immunity
Decrease humoral immunity
Deficiency of complement proteins
Increase humoral immunity
Increased cell mediated immunity
A 75 YRS old patient presented with a fever of 39°C and a cough productive of yellowish sputum. Gram
stain of the sputum shows small gram-negative rods. There is no growth on blood agar, but colonies do
grow on chocolate agar supplemented with hemin(factor X and NAD (factor V).Which one of the
following bacteria is the most likely cause of her pneumonia?

Bordetella pertussis
Haemophilus influenzae
 Klebsiella pneumoniae
Legionella pneumophila
Pseudomonas aeruginosa

A 60 year old patient resident of a nursing home presents to the emergency department with a fever of
104f ,shaking chills, severe pain to the right side of the chest that worsens with breathing and a
productive cough with blood tinged sputum .Gram stain revealed gram positive diplococci. What is the
diagnosis
Meningitis

Mumps

Pneumonia

Chicken pox

Rabies

Which of the following pathologic processes has most likely occurred in a pulmonary nodule due to
infection by Mycobacterial tuberculosis?

Caseous necrosis

Coagulative necrosis

Fat necrosis

Fatty change

Gangrenous necrosis

A patient presented with the history sore throat and fever. On examination, throat and tonsils were
inflamed with yellowish exudate. Cervical lymph nodes were enlarged and tender. What is the most
likely pathogen involved?

Streptococcus agalactia

Streptococcus pyogenes

Streptococcus pneumoniae

Streptococcus mutans

Streptococcus viridans

CVS (4micro)

A patient presented with a history of high grade fever with chills and rigors, severe headache and
mayalgias after mosquito bite. After a few days patient also developed black coloured urine.
Complete blood count showed severe anemia and renel function test were deranged indicating acute
renal failure. Diagnosis of black water fever was made. Which one of the following parasite is the most
likely causative organism

Plasmodium falciparum

Trypansoma cruzii

Ascaris lumbricoides

Entamoeba histolytic

Leishmanial Donovanii

A 24-year-old medical student was seen by her primary care physician because of sudden
onset of fever (104°F), chills, severe headache, pain around the eyeballs, muscle and severe
bone pain. O/E Maculopapular rash and enlarged LNs. Doctor was suspecting as a viral
infection, caused by a bite of mosquito.
Lab investigations: IgM antibodies to one of the flavi virus detected. What is the causative
organism

Dengue virus
Marburg virus
Ebola virus
Varicella zoster
Rabies virus

A patient presented with intermittent fever, weakness, and weight loss with distension of
abdomen. On examination, massive enlargement of the spleen and Hyperpigmentation of the
skin was noted. There was prevalence of sand flies in that area
What is the causative organism in this case
Plasmodium vivax

Trypansoma cruzii

Ascaris lumbricoides

Entamoeba histolytica

Leishmanial Donovanii

RESPIRATORY TRACT INFECTIONS , URINARY TRACT INFECTION, GENITAL

TRACT INFECTION
 MCQs Total marks 17 date
28may 18
1. A 24 year old female patient presented with the history of burning while passing urine, urgency
and supra pubic pain. In urine analysis, Pus cells were numerous. E.coli was isolated on culture.
What is the route of transmission of E.coli in urinary tract
A. By ascending spread of patients own fecal flora
B. By ascending spread of patients own skin flora
C. By descending spread of patients own fecal flora
D. By descending spread of patients own skin flora
E. By descending spread of patients own mouth flora
2. Regarding the above mentioned case, urine routine examination will show
A. Urobilinogen positive
B. protein positive
C. Nitrite positive
D. Glucose positive
E. Alkaline pH
3. A case of cystitis was diagnosed on the basis of urine RE and culture. pH of urine on urine
routine examination was 8.5 (alkaline).
Which could be the most likely gram negative organism involved in this case
A. Uro pathogenic E.coli
B. Staphylococcus saprophyticus
C. Proteus mirabilis
D. H. Influenzae
E. Compylobacter jejuni

4. A 35 year old sexually active female presented with a history of small bumps on her vulva. On
examination, some of the bumps appear to be small and flat and some were large and raised and
shaped like cauliflower. Provisional diagnosis of genital warts was made.
Most likely causative organism involved in this case is
A. Herpes simplex virus
B. Human papilloma virus
C. Hepatitis B virus
D. Hepatitis C virus
E. HIV

5. A 45 year old man presented with the complaints of yellowish colored discharge from
urethra, dysuria and urethral discomfort. Past history revealed sexual interaction with
multiple partners.
On gram stain of urethral discharge gram negative diplococci were seen.
The organism involved is:
A. Chlamydia trachomatis
B. Neisseria gonorrhoeae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
 E. Treponema pallidum
6. Which of the following structures are responsible for adherence of the offending microbe
to the urethral mucosa
A. Capsule
B. Pili
C. Peptidoglycan
D. Lipopolysaccharide
E. Flagella

7. In a case of urethritis in a 25 years old sexually active man, Chlamydia trachomatis was
the causative organism.
Chlamydia is
A. An obligate extracellular bacteria
B. An obligate intracellular bacteria
C. Facultative anaerobic bacteria
D. Aerobic bacteria
E. Microaerophilic bacteria

8. A patient presented with the history of flank pain. On ultrasound, struvite stones were
identified
Which bacteria promote the formation of struvite stones in kidneys
A. Chlamydia trachomatis
B. E.coli
C. Klebsiella
D. Proteus
E. Pseudomonas
9. A urine analysis of 85 year old bed ridden patient with indwelling urinary catheter
revealed numerous pus cells, indicative of UTI.
Which gram negative organism would be most likely involved in this case
A. Chlamydia trachomatis
B. E.coli
C. Klebsiella
D. Proteus
E. Pseudomonas
10. A sexually active 26 year old female presented with the complaints of malodorous thin
grayish vaginal discharge with mild vulval irritation. History of recent intake of antibiotics is
positive.
Provisional diagnosis of Bacterial vaginosis was made.
In bacterial vaginosis
A. The lactobacilli population is reduced greatly, while populations of
various anaerobes and G vaginalis are increased
B. The E.coli population is reduced greatly, while populations of various
anaerobes and G vaginalis are increased
 C. The Treponema pallidum population is reduced greatly, while populations of
various anaerobes and G vaginalis are increased
D. The Klebsiella pneumoniae population is reduced greatly, while populations
of various anaerobes and G vaginalis are increased
E. The pseudomonas population is reduced greatly, while populations of various
anaerobes and G vaginalis are increased
11.In case of genital herpes, most likely type of herpes virus involved is
A.HSV 8
B.HSV 2
C.HSV 3
D.HSV 4
E.HSV 5

12. A 32-year-old-woman complained of abdominal pain and fever. She had been using
IUCD for about 6 years and she had it removed one month before. An abdominal
ultrasonography showed unilateral ovarian abscess. Unilateral oophorectomy was performed.
In the histopathological examination of the specimen sulfur granules were observed.
Most likely pathogen involved is
A. Actinomyces israelii
B. Bacillus cereus
C. Clostridium perfringens
D. E.coli
E. Klebsiella pneumoniae

13. Congenital infections are due to pathogens that are transmitted from mother to child
during pregnancy (transplacentally) or delivery (peripartum). Which of the following
infections is transmitted at the time of birth, while the baby passes through the birth canal
A. rubella
B. Streptococcus agalactae
C. Toxoplasma
D. Staphylococcus aureus
E. Treponema Pallidum

14. TORCH infections are vertically transmitted infections that are capable of significantly

influencing fetal and neonatal morbidity and mortality. Which of the following is NOT included
in TORCH

A. T for toxoplasmosis
B. O for others (including syphilis, varicella-zoster virus, parvovirus B19) 
C. R for rubella
D. C for cytomegalovirus (CMV)
E. H for human immunodeficiency virus (HIV)
 

15. An eight month pregnant lady consults you regarding her report, which shows Rubella IgG
Positive. How will you interpret the report for her
A. The lady is protected but the infant is not protected
B. The lady has immunity and there is no danger to the fetus.
C. The baby has acquired the infection.
D. Retesting should be done to confirm the report
E. Testing for IgM should be done

16. Which one of the following best describes the pathogenesis of rheumatic fever?     
A. An exotoxin produced by  Streptococcus pyogenes that acts as a superantigen
damages cardiac muscle.
B. An exotoxin produced by  Streptococcus pyogenes that ADPribosylates a G
protein damages joint tissue.    
C.  Antibody to the capsular polysaccharide of Streptococcus pyogenes cross-
reacts with joint tissue and damages it.   
D. Antibody to the M protein of  Streptococcus pyogenes cross reacts with
cardiac muscle and damages it.  
E. Endotoxin produced by  Streptococcus pyogenes activates macrophages to
release cytokines that damage cardiac muscle

17. Regarding influenza virus and the disease influenza, which one of the following statements
is TRUE?
A. Both the killed and the live, attenuated vaccines induce lifelong immunity.
B. Influenza B virus causes more severe disease and epidemics than does influenza A
virus.
C. Antigenic drift involves major changes in antigenicity that result from reassortment
of the segments of its RNA genome.
D. The classification of influenza viruses into A, B, and C viruses is based on antigenic
differences in their hemagglutinin.
E. Its surface proteins, hemagglutinin and neuraminidase, have multiple serological
types.

African sleeping sickness is spread by the bite of

Sand fly
Testse fly
Deer fly
House fly
Dragon fly

Reproduction (4)

A 45 years old man presented with the complaints of yellowish colored discharge from urethra,
dysuria and urethral discomfort. Past history revealed sexual interaction with multiple partners.
 On gram stain of urethral discharge gram negative diplococci were seen.
The organism involved is:
Chlamydia trachomatis
Neisseria gonorrhoeae
Staphylococcus aureus
Streptococcus pneumoniae
Treponema pallidum
In case of genital herpes, most likely type of herpes virus involved is
A.HSV 8
B.HSV 2
C.HSV 3
D.HSV 4
E.HSV 5
A 32-year-old-woman complained of abdominal pain and fever. She had been using IUCD for
about 6 years and she had it removed one month before. An abdominal ultrasonography
showed unilateral ovarian abscess. Unilateral oophorectomy was performed. In the
histopathological examination of the specimen sulfur granules were observed.
Most likely pathogen involved is
Actinomyces israelii
Bacillus cereus
Clostridium perfringens
Escherichia coli
Klebsiella pneumoniae
What kind of lesions appear in the primary stage of syphilis
Chancre
Chancroid
Thrush
gumma
granuloma

Case scenario A
A 24 year old female patient presented with the history of burning while
passing urine, urgency and supra pubic pain. In urine analysis, Pus cells
were numerous. E.coli was isolated on culture.
1.What is the route of transmission of E.coli in urinary tract
F. By Ascending spread of patients own fecal flora
G. By Ascending spread of patients own skin flora
H. By descending spread of patients own fecal flora
I. By descending spread of patients own skin flora
 J. By descending spread of patients own mouth flora
2. Regarding the above mentioned case, urine RE will show
F. Urobilinogen positive
G. Protein positive
H. Nitrite positive
I. Glucose positive
J. Alkaline pH
Case scenario B
A case of cystitis was diagnosed on the basis of urine RE and culture. pH of urine
on Urine Routine examination was 8.5 (alkaline).
3. Which could be the most likely gram negative organism involved in this
case
F. Uro pathogenic E.coli
G. Staphylococcus saprophyticus
H. Proteus mirabilus
I. H.Influenzae
J. Compylobacter jejuni

4. Regarding the above mentioned case of cystitis, what is the pathogenic

mechanism of involved organism
A. produces urease and makes the urine alkaline and promote the growth of
the bacteria
B. produces nitrates makes the urine acidic and promote the growth of the
bacteria
C. produces nitrates and makes the pH of the urine neutral and promote the
growth of the bacteria
D. produces urease and makes the urine alkaline and stop the growth of the
bacteria
E. produces nitrites and makes the urine alkaline and stop the growth of the
bacteria
Case scenario C
A 45 year old man presented with the complaints of yellowish colored
discharge from urethra, dysuria and urethral discomfort. Past history
revealed sexual interaction with multiple partners.
On gram stain of urethral discharge gram negative diplococci were isolated
5. The organism involved is:
F. Chlamydia trachomatis
 G. Niessieria gonorroheae
H. Staphylococcus aureus
I. Streptococcus pneumoiae
J. E.coli
6. What is the route of transmission in the above mentioned case
A. Feco oral
B. Sexual interaction
C. Inhalation
D. Through blood transfusion
E. Through dental procedures

Case scenario D
In a case of urethritis in a 25 years old sexually active man, Chlamydia
trachomatis was the causative organism.
7. Chlamydia is
F. An Obligate extracellular bacteria
G. An Obligate intracellular bacteria
H. Facultative Anaerobic Bacteria
I. Aerobic Bacteria
J. Microaerophilic Bacteria

8. A patient presented with the history of flank pain. On ultrasound,

struvite stones were identified .Which bacteria promotes the formation
struvite stones in kidneys
F. Chlamydia trachomatis
G. E.coli
H. Klebsiella
I. Proteus
J. Pseudomonas
Case scenario E
A urine analysis of 85 year old bed ridden patient with indewelling urinary
catheter revealed numerous pus cells, indicative of UTI.
9. Which gram negative organism would be most likely involved in this case
F. Chlamydia trachomatis
G. E.coli
 H. Klebsiella
I. Proteus
J. Pseudomonas

Case scenario F
A sexually active 26 year old female presented with the complaints of malodourus
thin grayish vaginal discharge with mild vulval irritation. History of recent intake
of antibiotics is positive.
Provisional diagnosis of Bacterial vaginosis was made.
10. In bacterial vaginosis
F. The lactobacilli population is reduced greatly, while populations of various
anaerobes and G vaginalis are increased
G. The lactobacilli population is increased greatly, while populations of various
anaerobes and G vaginalis are also increased
H. The lactobacilli population is reduced greatly, while populations of various
anaerobes and G vaginalis are also reduced
I. The lactobacilli population is reduced greatly, while populations of various
anaerobes and G vaginalis remain normal
11.Lactobacilli in vagina are protective as
A. They produce nitrogen peroxide and keep the environment acidic
B. They produce hydrogen peroxide and keep the environment acidic
C. They produce urease and keep the environment acidic
D. They produce ammonia and keep the environment acidic
E. They produce uric acid and keep the environment acidic
Case scenario G
A 32-year-old-woman complained of abdominal pain and fever. She had
been using IUD for about 6 years and she had it removed one month before. On
the physical examination there was a fever of 39ºC and a mild diffuse
abdominal sensitivity. An abdominal ultrasonography showed unilateral tubo
ovarian abscess and unilateral salpingo ophorectomy was performed. In the
pathological examination of the specimen sulfur granules were observed.
12. Most likely pathogen involved is
F. Actinomyces israelii
G. Bacillus cereus
H. Clostridium perfringens
I. E.coli
J. Klebsiella pneumoniae
 Case scenario H
A 35 year old sexually active female presented with a history of small bumps
on her vulva. On examination, some of the bumps appear to be small and flat and
some were large and raised and shaped like cauliflower. Provisional diagnosis of
genital warts was made.
13. Most likely causative organism involved in this case is
F. Herpes simplex virus
G. Human papilloma virus
H. Hepatitis B virus
I. Hepatitis C virus
J. HIV
14. In the above mentioned case patient is at a risk of developing
A. carcinoma of the cervix and male external genitalia
B. carcinoma of the cervix and testes
C. carcinoma of the colon and rectum
D. carcinoma of the gall bladder and liver
E. carcinoma of the breast and bones
15. In a case of genital herpes, the chief complaint would be
A. Pain less genital ulcers
B. Painful genital ulcers
C. Maculopapular rash on the body
D. Granulomas of skin
E. Arrhythmias
16. In case of genital herpes, most likely type of herpes virus involved is
A.HSV 8
B.HSV 2
C.HSV 3
D.HSV 4
E.HSV 5
Case scenario I

A 25 year old woman is treated with a course of broad spectrum antibiotics

for severe pelvic inflammatory disease. She now reports a thick curdy, pruritic
vaginal discharge.
 16. Which of the following is the most prevalent microorganism in the
vagina and may also be protective
A. Streptococci
B. Bacteroides fragilis
C. E.coli
D. Lactobacillus species
E. Klebsiella pneumoniae
17. In the above mentioned case the most likely causative
organism could be
A. Candida albicans
B. E.Coli
C. Klebsiella Pneumoniae
D. Lactobacillus
E. H.influenzae
Case scenario J
Several days after an unprotected sexual interaction, a healthy 21 year old
male develops pain and pus on urination. A gram stain reveals gram negative
diplococci
18. Which is the causative organism involved
A. Niessieria meningitides
B. Niessieria gonorroheae
C. H.influenzea
D. Streptococcus agalactie
E. E.coli
19. Which of the following structures are responsible for adherence of the
offending microbe to the urethral mucosa
F. Capsule
G. Pilli
H. Peptidoglycan
I. Lipopolysaccharide
J. Flagella
Case scenario K
A 23 year old patient presented with complaints of fever, photophobia,
nausea, vomiting and neck stiffness
 20. Provisional diagnosis could be
A. Meningitis
B. Pharyngitis
C. Pneumonia
D. Sinusitis
E. Tonsillitis
21. In the above mentioned case listeria monocytogenes was isolated. It is
A. Gram negative rod
B. Gram positive rod
C. Gram negative coccus
D. Gram positive coccus
E. Gram variable rod
22. Pathogenic mechanism of listeria monocytogenes
A. Intracellular movement of organism with the help of filopods
B. Intracellular movement of organism with the help of pili
C. Extracelular movement of organism with the help of filopods
D. Extracelular movement of organism with the help of pili
E. Extracellular movement of organism with the help of flagella
Case scenario L
A patient presented with the history of high grade fever, nausea vomiting,
photophobia and neck stiffness. There was also a history of untreated pneumonia
for 5 days.

23.Regarding route of transmission

A. Hematogenous spread secondary to pneumonia
B. lymphatogenous spread secondary to pneumonia
C. Hematogenous spread secondary to osteomylitis
D. lymphatogenous spread secondary to osteomylitis
E. lymphatogenous spread secondary to gastroenteritis

• Case scenario M
A new born baby presented with the history of irritability lethargy, failure to
thrive
24.A gram positive cocci isolated is
A. Listeria monocytogenes
B. Streptococcus agalactie
 C. Escherichia coli
D. Clostridium botulinum
E. Clostridium perferingens
25. The route of infection of listeria monocytogenes in neonatal
meningitis is
A. Acquired during delivery through birth canal of mother colonized
with listeria
B. Through mother’s milk
C. Through ingestion of contaminated honey
D. Through inhalation
E. Through lymphatogenous spread
Case scenario N
5 cases of neonatal meningitis were admitted in the emergency department in a
week. All of them had the history of being fed on a particular milk formula
26. Which could be the likely causative organism involved in this case
A. Enterobacter cloacae
B. Enterobactrer sakazaki
C. Enterococcus feacalis
D. E.coli
E. Balantidium coli

Case scenario O
27. A 35 year old patient presented with complaints of fever, photophobia,
nausea, vomiting and neck stiffness. Culture of CSF revealed the presence
of gram negative diplococci. The causative organism is
A. Niesseria meningitides
B. Enterococcus feacalis
C. Enterobactrer sakazaki
D. Enterobacter cloacae
E. E.coli
Case scenario P
A patient was diagnosed with meningitis and the causative organism was
Heamophilus influenzae
28. What is the route of infection of this organism
 A. Hematogenous spread secondary to upper respiratory tract infection
B. Lymphatogenous spread secondary to upper respiratory tract infection
C. Hematogenous spread secondary to urinary tract infection
D. Lymphatogenous spread secondary to urinary tract infection
E. Hematogenous spread secondary to gastrointestinal tract infection
29. Which virulence factor is involved that helps Heamophilus influenzae
in escaping phagocytosis
A. Pilli
B. Fimbriae
C. Exotoxin
D. Endotoxin
E. Capsular polysaccharide type B

Case scenario Q
30. A patient is diagnosed with meningitis secondary to the skull fracture in a road
traffic accident. Gram stain of CSF revealed gram positive diplococci
Most likely micro-organism involved is
A. Niesseria meningitides
B. Enterococcus feacalis
C. Enterobacter cloacae
D. E.coli
E. Streptococcus pneumoniae

GIT MCQs

Your patient is a 65-year-old woman who is several days post-op following

removal of her carcinoma of the colon. She now spikes a fever and has a cough,
and chest X-ray shows pneumonia. While being treated with the appropriate
antibiotics for two weeks, she develops severe diarrhea. What is the most likely
diagnosis.
(A) Pseudomembranous colitis
(B) enteric fever
(C) gastric ulcer
(D) diarrhea due to parasitic infection
(E) gastric carcinoma
Regarding the above mentioned case, which is the most likely organism involved
(A) Clostridium tetani
(B) Clostridium difficile
(C) Clostridium botulinum
(D) Clostridium perfringens
(E) Clostridium septicum

You’re a public health epidemiologist who is called to investigate an outbreak of

bloody diarrhea in 16 people. You find that it is associated with eating rare a
burgers in a particular fast-food restaurant. A culture of the remaining uncooked
hamburger grows a lactose fermenting, gram-negative rod . Which one of the
following bacteria is the most likely cause of this outbreak?
(A) Escherichia coli
(B) Salmonella enterica
(C) Salmonella typhi
(D ) Shigella dysenteriae
(E) Vibrio cholera

A 20-year-old woman presented with the complaints of severe watery diarrhea

with rice water consistency. A Gram stain of the stool reveals curved gram-
negative rods. Which one of the following bacteria is the most likely cause of this
infection?
(A) Escherichia coli
(B) Helicobacter pylori
(C) Proteus mirabilis
(D) Pseudomonas aeruginosa
(E) Vibrio cholera

Which of the following statements best describe the pathogenesis in this case
(A) Production of toxin that release IL-1, IL-2and TNF
(B) Production of toxin that acts as a neurotoxin
(C) Production of toxin that activates adenylate cyclase
(D) Production of toxin that cause myonecrosis
(E) Production of toxin that cause respiratory epithelium damage
 Your patient is a 6-year-old boy with bloody diarrhea for the past 2 days
accompanied by fever to 102°F and vomiting. The cultures grew, gram-negative
rod that formed colorless colonies on MacConkey agar. Which one of the
following bacteria is the most likely cause of this infection?
(A) Clostridium perfringens
(B) Clostridium difficile
(C) Staphylococcus aureus
(D) Shigella dysenteriae
(E) Streptococcus pyogenes

The toxin released by the causative organism is in the above mentioned case;

(A) Inhibit the protein synthesis of enterocytes

(B) Increase the cAMP in enterocytes
(C) Act as a super antigen
(D) Activate the cGMP in enterocytes
(E) Activate the production of cytokines from the Helper T cells
Which one of the following hepatitis B serological markers indicate the immunity
produced after vaccination against the HBV.
A) HBsAg
B) HBsAb
C) HBeAg
D) HBeAb
E) HBcIgM

Which of the hepatitis B serological markers show the complete recovery of the
disease
(A) HBsAg
(B) HBsAb
(C) HBeAg
(D) HBeAb
(E) HBcIgM

Your patient is a 30-year-old woman with non bloody diarrhea for the past 14
hours. Which one of the following organisms is LEAST likely to cause this illness?
(A) Clostridium difficile
(B) vibrio cholerae
(C) E.coli
 (D) Salmonella enteritidis
(E) Shigella dysentery
Five hours after eating reheated rice at a restaurant, a 24-year-old woman and her
husband both developed nausea, vomiting, and diarrhea. Which one of the
following organisms is the MOST likely to be involved?
(A) Clostridium perfringens
(B) Enterotoxigenic Escherichia coli
(C) Bacillus cereus
(D) Salmonella typhi
(E) Bacillus anthrax

Two hours after a delicious Thanksgiving dinner of barley soup, roast turkey,
stuffing, sweet potato, green beans, cranberry sauce, and pumpkin pie topped with
whipped cream, the Smith family of four experience vomiting and diarrhea. All of
the patients have vomiting as prominent feature
Which one of the following organisms is MOST likely to cause these symptoms?
(A) Shigella flexneri
(B) Campylobacter jejuni
(C) Staphylococcus aureus
(D) Salmonella enteritidis
(E ) Bacillus anthrax

In food poisoning, the reason for excessive vomiting is

(A) Activation of vomiting centre by cytokines in the brain
(B) Gastric ulcer
(C) Irritation of gastric epithelium by the causative organism
(D) Irritation of intestinal epithelium by the causative organism
(E) Gastro esophageal reflux

Which one of the following organisms causes diarrhea by producing an

enterotoxin that increases adenylate cyclase activity within enterocytes?
(A) Salmonella
(B) Bacteroides fragilis
(C) Staphylococcus aureus
(D) Enterococcus faecalis
(E) Vibro cholera

Regarding Entamoeba histolytica, which one of the following is most accurate?

 (A) E. histolytica causes “flask-shaped” ulcerations in the colon
mucosa.
(B) Domestic animals such as dogs and cats are the main reservoir of E.
histolytica.
(C) In the microscope, E. histolytica is recognized by having two sets of
paired flagella.
(D) E. histolytica infections are limited to the intestinal mucosa and do not
spread to other organs.
(E) The infection is typically acquired by the ingestion of the trophozoite
in contaminated food and water.

Regarding G. lamblia, which one of the following is most accurate?

(A) The drug of choice for giardiasis is chloroquine.
(B) In giardiasis, ova and parasite (O&P) analysis of the stool reveals
sporozoites in the feces.
(C) G. lamblia produces an enterotoxin that increases cyclic AMP within
the enterocyte, resulting in diarrhea.
(D) G. lamblia infection is acquired by ingestion of food or water
contaminated with human feces only (i.e., there is no animal reservoir for
this organism).
(E) Infection by G. lamblia occurs principally in the small intestine,
frequently resulting in the malabsorption of fat and foul-smelling,
frothy, fat-containing stools.

A young man experienced anorexia, nausea, and abdominal bloating. For the last 2
days, she has had explosive watery diarrhea. An examination of her stool revealed
pear-shaped, flagellated, motile organisms. Of the following, which one is the most
likely cause of this infection?
(A) C. hominis
(B) E. histolytica
(C) G. lamblia
(D) T. vaginalis
(E) Balantidium coli

. A 40 year male admitted in hospital with a history of fever and right-upper-

quadrant pain. He reports that he had bloody diarrhea 2 months ago. A CT scan
reveals a liver abscess. Aspiration of material from the abscess was performed.
Microscopic examination revealed motile, nonflagellated trophozoites with
ameboid movement. Of the following, which one is the most likely cause of this
infection?
 (A) C. hominis
(B) E. histolytica
(C) G. lamblia
(D) T. vaginalis
(E) balantidium coli

Your patient is a 30-year-old man with persistent watery diarrhea for 2 weeks. He
is HIV antibody positive with a CD4 count of 10. Routine stool culture revealed no
bacterial pathogen. Ova and parasite analysis revealed cysts that stained red in an
acid-fast stain. Of the following, which one is the most likely cause of this
infection?
(A) Cryptosporidium parvum
(B) E. histolytica
(C) G. lamblia
(D) T. vaginalis
(E) Balantidium coli
Several hours after dining on sweet and sour chicken and pork fried rice at the
home of an Asian friend, a 34-year-old car salesman exhibits abdominal
discomfort, nausea, and vomiting. In the middle of the night he awakens with
watery diarrhea. Which of the following pairs of organisms is routinely responsible
for food poisoning?
(A) Clostridium botulinum and Bacillus anthracis
(B) Clostridium difficile and C. botulinum
(C) Clostridium perfringens and B. cereus
(D) Clostridium tetani and B. anthracis
(E) Clostridium tetani and B. cereus

An old healthy male develops profuse watery diarrhea, severe cramping, and
abdominal pain. He is diagnosed with Escherichia coli-related diarrhea. Which of
the following E. coli types is characterized by the presence of heat-labile (LT) and
heat-stable (ST) toxin proteins?
(A) Enteroinvasive (EIEC)
(B) Enterotoxigenic (ETEC)
(C) Enterohemorrhagic (EHEC)
(D) Enteropathogenic (EPEC)
 (E) Enteroaggregative E.coli
Which of the following best describes E. coli 0157/H7, the etiologic bacterium
responsible for the outbreak of diarrhea.
(A) It penetrate the mucosal lining of stomach
(B) It acts my increasing the cyclic AMP in enterocytes
(C) It secretes an erythrogenic toxin that causes the characteristic signs of
scarlet fever
(D) It secretes an exotoxin that has been called “verotoxin” and
“Shiga-like toxin”; infection is mediated by specific attachment to
mucosal membranes
(E) It is responsible for producing rice water stool
A patient presented with complaints of pain in epigastrium, Helicobacter pylori
was found to be the causative organism. Helicobacter pylori survive in the acidic
environment of the stomach by producing
(A) Nitrate
(B) Urease
(C) Nitrite
(D) Hydrochloric acid
(E) Phosphate
A patient is diagnosed with H.pylori gastritis. He is now at a risk of developing
(A) Eosophageal Carcinoma
(B) Colorectal Carcinoma
(C) Gastric Carcinoma
(D) Bladder carcinoma
(E) Cervical carcinoma
In the above case, which test should be done to confirm the effectiveness of
treatment
(A) H.pylori antibody test in serum
(B) H.pylori antigen test in stool
(C) Urea breath test
(D) Culture/sensitivity
(E) Stool routine examination

A14 month old baby presented with the history of loose watery stools and vomiting
for two days. The provisional diagnosis was Rota virus infection. Rota virus
infection is less common among the children of age upto 6 months in beast feed
baby because
(A) colostrum IgG protects newborns up to the age of 6 months.
(B) colostrum IgE protects newborns up to the age of 6 months.
(C) colostrum IgA protects newborns up to the age of 6 months.
(D) colostrum IgM protects newborns up to the age of 6 months.
(E) colostrum IgD protects newborns up to the age of 6 months.
A pregnant woman was diagnosed to have hepatitis B infection. Which serological
marker should be done to know the transmissibility of virus to the baby
(A) HBsAg
(B) HBsAb
(C) HBeAg
(D) HBeAb
(E) HBcIgM

All nursing staff working in a liver clinic were advised to have vaccination against
hepatitis B Virus. Some of the staff members have already had the vaccine few
months back. Which serological markers should be done to know whether the
vaccinated members still have the immunity coverage due to the previous
vaccination
(A) HBsAg
(B) HBsAb
(C) HBeAg
(D) HBeAb
(E) HBcAb

Which of the following could be the most common complication of Entamoeba

histolytica infection
(A) liver abscess
(B) meningitis
(C) pneumonia
(D) pharyngitis
(E) laryngitis
A family routinely consumes unpasteurized milk, claiming “better taste.” Several
members experience a sudden onset of crampy abdominal pain, fever, and profuse
bloody diarrhea. Which is the most likely causative organism
(A) Bacteroides fragilis
 (B) Campylobacter jejuni
(C) Salmonella typhi
(D) Staphylococcus aureus
(E) Enterococcus faecalis

A 30-year-old female was admitted for complaints of bloody diarrhea. Colonoscopy

revealed a diffusely red mucosa involving the rectum and sigmoid colon. Biopsy of
the affected region reveals inflammation of entire mucosa with formation of crypt
abscess. Which of the following is most likely diagnosis:
a. Intermediate colitis
b. Microscopic colitis
c. Ulcerative colitis*
d. Diversion colitis
e. Crohns disease
A 28-year-old man complains of difficulty in swallowing and a tendency to
regurgitate. Manometric studies of the esophagus show absence of peristalsis and
increased intraesophageal pressure. Which of the following is the most likely
diagnosis?
a. Achalasia*
b. GERD
c. Esophageal stricture
d. Zanker’s diverticulum
e. Schatzki ring
A 14-year-old girl is brought to the physician for complains of mal-absorption.
Her symptoms improved when physician advised change in her diet. Which of
the following is the most likely diagnosis?
a. Celiac disease*
b. Cystic fibrosis of the pancreas
c. Giardiasis
d. Tropical sprue
e. Whipple disease
A 50-year-old obese man comes to the physician with complaints of indigestion
after meals and heartburn. Endoscopic biopsy of lower esophagus shows
thickening of the basal layer of the squamous epithelium and scattered
intraepithelial eosinophils. Which of the following is the most likely diagnosis?
a. Esophageal varices
b. Mallory-Weiss syndrome
c. GERD*
d. Barrett esophagus
e. Candidiasis
A 60-year-old man undergoes routine colonoscopy. A small, raised, mucosal
nodule measuring 4mm in diameter is identified in the rectum and resected.
Microscopic examination reveals goblet cells and absorptive cells with
exaggerated crypt architecture, but no signs of nuclear atypia. Which of the
following is the most likely diagnosis?
a. Adenomatous polyp
b. Hyperplastic polyp*
c. Inflammatory polyp
d. Peutz-Jeghers polyp
e. Hamartomatous polyp
A 50-year-old man presented in OPD with history of persistent nausea and
vomiting for five years. He undergoes upper GI endoscopy, and a small area of
gastric fundal mucosa shows loss of rugal folds. Biopsies of lesion shows well-
differentiated adenocarcinoma confined to the mucosa. Previous biopsies
showed a pattern of chronic gastritis. Which of the following is the most likely
risk factor?
a. Inherited APC gene mutation
b. Helicobacter pylori infection*
c. Chronic alcohol abuse
d. Use of non-steroidal anti-inflammatory drugs
e. Vitamin B12 deficiency
Regarding acute hepatitis which one of the following is the most characteristic
feature:
a. Bridging fibrosis

b. Bridging necrosis

c. Fibrous tissue deposition

d. Ballooning degeneration *

e. Peri-portal necrosis

A farm worker presents with complaint of right hypochondriac pain.

Hepatocellular carcinoma was diagnosed on liver biopsy. Which of the
following is the most likely etiological factor associated with this condition?
a. Aflatoxins*

b. Hydrocarbons

c. Aromatic amines

d. Saccharine
 e. Cyclamates

A 25 year old lady presents with jaundice, pruritis, peri-ocular xanthomas. Her
laboratory results indicate significantly increased level of alkaline phosphatase
as well as a positive test for antimitochondrial antibodies. Which of the
following is most likely diagnosis?
a. Leptospirosis
b. Macronodular cirrhosis
c. Primary biliary cirrhosis*
d. Micronodular cirrhosis
e. Metabolic liver disease
A 40-year-old woman has frequent indigestion after meals. Cholecystectomy
revealed the presence of cholesterol gall stones. Which one of the following
conditions contributes to formation of these gall stones?
a. Hyposaturation of bile with cholesterol
b. Hypermotility of gallbladder
c. Hyposecretion of mucus in gallbladder
d. Accelerated cholesterol crystal nucleation*
e. Infection of biliary tract with E-coli

A 12 years old girl presented with recurrent attacks of severe acute pancreatitis.
Which of the following factor is most commonly associated with the development
of this disease?

a. Gain of function mutations in SPINK1

b. Gain of function mutations in PRSS1*
c. Gain of function mutations in CFTR
d. Activation of Transforming growth factor ß
e. Production of Platelet derived growth factors