- An amino acid with no ionizable R group would

be electrically neutral at this pH and is termed a

zwitterion.
- The term zwitterion defines an electrically
neutral molecule with one positive and one
negative charge at different sites within that
PLE DAY 1 molecule.
BIOCHEMISTRY
1. The following is true about the Lock and Key 3. Which of the following statements is true?
Model: I. The aldehyde and ketone moieties of the
I. The substrate molecule has a specific 3- carbohydrates with 5 and 6 carbons will spontane-
dimensional shape that allows it to fit into the ously react with alcohol groups present in the
specific 3-dimensional shape of an enzyme’s neighboring carbons to produce intramolecular
active site hemiacetals or hemiketals, respectively which will
II. Enzyme and substrates already exist in these result
specific 3-dimensional shapes. II. 5-membered ring structure resembles the organic
III. An interaction between the enzyme and substrate molecule furan, derivatives with this structure are
induces or changes the shape of the molecules to termed furanoses and those with 6-membered
produce a suitable fit. rings resemble the organic molecule pyran and
IV. Analogy first postulated in 1894 by Emil Fischer. are termed pyranoses
A. I, II, III, IV III. The ring structures of the carbohydrates can be
B. II, IV depicted by either Fischer- or Haworth, the
C. II, III, IV numbering of the carbons in carbohydrates
D. I, II, IV proceeds from the carbonyl carbon, for aldoses, or
Answer: D the carbon nearest the carbonyl, for ketoses.
ENZYME ACTION can occur two ways: IV. Glycogen is also highly branched where each
1. Lock and Key model branch is generated via the α-(1,6) link- age one
- Analogy first postulated in 1894 by Emil Fischer. glucose of a chain of α-(1,4)-linked glucose
- the substrate molecule has a specific 3- residues.
dimensional shape that allows it to fit into the A. I, II, III
specific 3-dimensional shape of an enzyme’s B. II,III, IV
active site. C. I,II, III, IV
- Both enzyme and substrate already exist in these D. I, II, IV
specific 3-dimensional shapes. Answer: C
2. Induced Fit model
- An interaction between the enzyme and substrate 4. What is the major form of stored carbohydrate in animals?
induces or changes the shape of the molecules to A. Glucose
produce a suitable fit. B. Glycogen
C. Starch
2. The following is NOT TRUE regarding the classification of D. None of the above
proteins Answer: B
I. The hydrophobic amino acids, this class of amino ● Glycogen - major form of stored carbohydrate in
acids, does not ionize nor participate in the animals
formation of H-bonds. ● Glucose - is the most important monosaccharide
II. The hydrophilic amino acids tend to inter- act with in humans. It is the storage form of carbohydrate,
the aqueous environment and are predominantly can be readily catabolized to generate energy
found on the exterior surfaces of proteins or in the even in the absence of oxygen, and most all other
reac- tive centers of enzymes. carbohydrates can be converted into glucose.
III. Each of the 20 α-amino acids found in proteins ● Starch is the major form of stored carbohydrate in
can be distinguished by the R group substitution plant cells.
on the α-carbon atom.
IV. An amino acid with an ionizable R group would be 5. The parents of a 7-month-old infant bring their son to the
electrically neutral at this pH and is termed a pediatrician because they have noticed that their child has a
dull response to outside stimuli. In addition, they note that
zwitterion.
their child exhibits an exaggerated startle response (sudden
A. I, II, III extension of arms and legs) to sharp sounds and that he
B. II,III, IV seems to be losing previously acquired motor and mental
C. I,II, III, IV skills. His pediatrician makes a diagnosis of Tay-Sachs
D. I, II, IV disease. Elevated intracellular levels of which of the
Answer: A following carbohydrate-containing compounds would provide
useful information for confirmation of this diagnosis?
A. Abnormal glycoogen

1
 B. aldohexoses
C. Aldoketoses
D. Gangliosides
Answer: D
Tay-Sachs Diseases
- ganglioside GM2 is not catabolize
- Consequence: ganglioside concentration is
elevated many times higher than normal.
- The functionally absent lysosomal enzyme is
β-N-acetyl hexosaminidase (more commonly
called hexosaminidase A).
- Under normal conditions, this enzyme cleaves N-
acetylgalac- tosamine from the oligosaccharide
chain of this com- plex sphingolipid, allowing
further catabolism to occur.
- Elevated GM2 results in:Irreversible brain
damage to infants, who usually die before the
age of 3 years.
6. The parents of an 18-month-old girl are alarmed at the
rapid deterioration in her motor skills and the appearance of
an engorged belly. They note that when their daughter tries
to follow the movement of an object she thrusts her head in
the direction of movement as if she cannot move her eyes
from side-to-side. Physical and laboratory examination
reveals that the child is suffering from Gaucher disease.
Which of the following carbohydrate- containing compounds
would be expected to be elevated in macrophages from this
patient?
A. abnormal glycogen
B. cerebrosides
C. glycosaminoglycans
D. GM2 ganglioside
Answer B:
Gaucher disease
- Lysosomal accumulation of glucosylceramide (glu-
cocerebroside) which is a normal intermediate in
the catabolism of globosides and gangliosides.
- Gaucher disease results from defects in the gene
encoding the lysosomal hydrolase: acid β-
glucosidase, also called glucocerebrosidase.
- The hallmark feature of Gaucher disease is the
presence of lipid-engorged cells of the
monocyte/macrophage lineage with a
characteristic appearance in a variety of
tissues.
7. Hypersensitive individuals have IgE to specific antigens
(eg, pollen, bee venom) on the surface of their leukocytes
(monocytes, macrophages, basophils, eosinophils). When
these individuals are challenged with antigen, the antigen–
IgE com-plexes induce synthesis and release of which of the
following physiologically potent lipids?
A. arachidonic acid
B. leukotriene B4
C. platelet-activating factor (PAF)
D. prostaglandin E2
E. thromboxane A2 (TXA2)
Answer: C
Platelet-activating factor (PAF)
● Unique complex lipid of the plasmalogen family.
● PAF functions in:
○ Hypersensitivity
○ Acute inflammatory reactions
○ Anaphylactic shock by increased
vasopermeability
○ Vasodilation
○ Bronchoconstriction
● Excess production of PAF production may be
involved in the morbidity associated with toxic
shock syndrome and strokes.
8. Which of the following statements are true?
I. Fatty acids are long-chain hydrocarbon molecules
containing a carboxylic acid moiety at one end.
II. Nucleosides are composed of a nucleobase
(purine or pyrimidine) attached to ribose but
containing no phosphate.
III. The binding of CO to heme is much stronger than
that of oxygen and it is this preferential binding of
CO that is largely responsible for the asphyxiation
due to CO poisoning.
IV. Southern Blotting involves the analysis of RNA
following its attachment to a solid support.
A. I, II, III
B. II,III, IV
C. I,II, III, IV
D. I, II, IV
Answer: A
- Southern Blotting - the DNA to be analyzed is
first digested with a given restriction enzyme, then
the resultant DNA fragments are separated in an
agarose gel.
- Northern blotting involves the analysis of RNA
following its attachment to a solid support.
- Western blotting involves the analysis of
proteins following attachment to a solid support.
- The proteins are separated by size
SDS-PAGE and electrophoretically
transferred to nitrocellulose or nylon
filters.
9. Which of the statements is true regarding Vitamin H
I. Cofactor required of enzymes that are involved in
carboxylation reactions, for example, acetyl-CoA
carboxylase (ACC)
II. Deficiencies are generally seen only after long
antibiotic therapies, which deplete the intesti- nal
microbiota or following excessive consumption of
raw eggs.
III. Symptoms that may appear if deficient are
extreme exhaustion, drowsiness, muscle pain,
loss of appetite, depression, and grayish skin color
IV. found in numerous foods
A. I, II, III, IV
B. II, IV
C. II, III, IV
D. I, II, IV
Answer: A
Biotin (Vitamin H)
● Cofactor required of enzymes that are involved in
carboxylation reactions, for example, acetyl-CoA
carboxylase (ACC) and pyruvate carboxylase
2
 ● Found in numerous foods and is also ● Excess accumulation of vitamin A in the liver can
synthesized by intestinal bacteria and as such lead to toxicity, which manifests as:
deficiencies of the vitamin are rare. ○ bone pain
● Deficiencies are generally seen only after long ○ Hepatosplenomegaly
antibiotic therapies, which deplete the intestinal ○ Nausea
microbiota or following excessive consumption of ○ diarrhea
raw eggs.
● The latter is due to the affinity of the egg white
protein, avidin, for biotin, preventing intestinal
absorption of the vitamin.
● Symptoms that may appear if biotin is deficient
are:
○ extreme exhaustion
○ Drowsiness
○ muscle pain
○ loss of appetite
○ Depression
○ grayish skin color
10. The following statement/s is/are TRUE regarding Vitamin
A deficiency or blindness:
I. Late symptoms include follicular hyper- keratosis,
increased susceptibility to infection and cancer,
and anemia equivalent to iron-deficient anemia.
II. Prolonged lack of vitamin A leads to deterioration
of the eye tissue through progressive
keratinization of the cornea, a condition known as
xerophthalmia.
III. Beta-carotene is a very effective antioxidant and is
suspected to reduce the risk of cancers known to
be initiated by the production of free radicals.
IV. Excess accumulation of vitamin A in the liver can
lead to toxicity, which manifests as bone pain,
hepatosplenomegaly, nausea, and diarrhea.
A. I, II, III
B. II,III, IV
C. I,II, III, IV
D. I, II, IV
Answer: B
Vitamin A
● stored in the liver and deficiency of the vitamin
occurs only after prolonged lack of dietary intake.
● The earliest symptoms of vitamin A deficiency
are night blindness.
● Additional early symptoms include:
○ follicular hyperkeratosis
○ increased susceptibility to infection and
cancer
○ anemia equivalent to iron-deficient
anemia
● Prolonged lack of vitamin A leads to
deterioration of the eye tissue through
progressive keratinization of the cornea, a
condition known as xerophthalmia.
● The increased risk of cancer in vitamin
deficiency is thought to be the result of a
depletion in β-carotene. Beta-carotene is a
very effective antioxidant and is suspected to
reduce the risk of cancers known to be initiated by
the production of free radicals.
● Potential benefit of increased β-carotene intake
to reduce the risk of lung cancer in smokers.

3
ANATOMY AND HISTOLOGY
1. Which of the following statements is TRUE
regarding the sternum
I. The sternal angle is formed by the
articulation of the manubrium with the
body of the sternum
II. It is an important surface landmark, and
it lies at the level of: the second costal
cartilage and intervertebral disc
between the fourth and fifth thoracic
vertebrae.
III. Body of the sternum articulates above
with the manubrium at the
manubriosternal joint and below with
the xiphoid process at the xiphisternal
joint.
IV. xiphoid process is a thin plate of
cartilage that becomes ossified at its
proximal end during adult life.
A. I, II, III
B. II,III, IV
C. I,II, III, IV
D. I, II, IV
Answer: C
2. The following structures are closely related are closely
related to the upper surface of the first rib and the clavicle as
they enter the upper limb. It is here that the nerves or
blood vessels may be compressed between the bones.
I. Brachial plexus of nerves (C5, 6, 7, 8, and T1)
II. Subclavian artery
III. Subclavian vein
IV. Thoracic nerve
A. I, II, III
B. II,III, IV
C. I,II, III, IV
D. I, II, IV
Answer: A
THORACIC OUTLET SYNDROMES
- The brachial plexus of nerves (C5, 6, 7, 8, and T1)
and the subclavian artery and vein are closely
related to the upper surface of the first rib and the
clavicle as they enter the upper limb.
- It is here that the nerves or blood vessels may be
compressed between the bones.
3. True regarding the blood supply of the heart:
I. The heart is innervated by sympathetic and
parasympathetic fibers of the autonomic nervous
system via the cardiac plexuses.
II. Activation of the parasympathetic nerves results in
a reduced rate and force of contraction by the
heart and a constriction of the coronary arteries.
III. Postganglionic sympathetic fibers terminate on the
sinoatrial and the atrioventricular nodes,cardiac
muscle fibers, and coronary arteries.
IV. Pain originating in the heart as the result of
ischemia results in the stimulation of the sensory
nerve endings in the myocardium.
A. I, II, III
B. II,III, IV
C. I,II, III, IV
D. I, II, IV
Answer: C
4. Distribution of Iliohypogastric nerve
A. External oblique, internal oblique, transversus
abdominis muscles of anterior abdominal wall;
skin over lower anterior abdominal wall and
buttock
B. External oblique, internal oblique, transversus
abdominis muscles of anterior abdominal wall;
skin of upper medial aspect of thigh; root of penis
and scrotum in males and mons pubis and labia
majora in females
C. Iliacus, pectineus, sartorius, quadriceps femoris
muscles; intermediate cutaneous branches to the
skin of the anterior surface of the thigh and by
saphenous branch to the skin of the medial side of
the leg and foot; articular branches to hip and
knee joints
D. Quadratus lumborum and psoas branches
muscles
Answer: A
● Ilioinguinal nerve (L1): External oblique, internal
oblique, transversus abdominis muscles of
anterior abdominal wall; skin of upper medial
aspect of thigh; root of penis and scrotum in males
and mons pubis and labia majora in females
● Femoral nerve (L2, L3, L4): Iliacus, pectineus,
sartorius, quadriceps femoris muscles;
intermediate cutaneous branches to the skin of the
anterior surface of the thigh and by saphenous
branch to the skin of the medial side of the leg and
foot; articular branches to hip and knee joints
● Segmental Brancehs: Quadratus lumborum and
psoas muscles
5. The lymphatic drainage of the labia majora is into the
A. internal iliac nodes.
B. superficial inguinal nodes.
C. inferior mesenteric nodes.
D. internal and external iliac nodes.
E. para-aortic nodes at the level of the first lumbar
vertebra.
Answer: B
6. A 21-year-old woman complaining of severe pain in the
right iliac region was seen in the emergency department.
Just before admission, she had fainted. On physical
examination, her abdominal wall was extremely tender on
palpation in the right iliac region, and some rigidity and
guarding of the lower abdominal muscles were noticed. A
vaginal examination revealed that a tender, “doughlike”
mass could be felt through the posterior fornix. The patient
had missed her last period. The diagnosis of a ruptured
ectopic pregnancy was made. In this ectopic pregnancy, the
embryo was implanted in the right uterine tube. Rupture of
the tube produced the symptoms and the signs that were
noted.
The tender, doughlike mass felt through the posterior
the wall of the vagina resulted from what?
4
A. A retroverted uterus
B. Blood in the pouch of Douglas
C. A full bladder
D. Blood in the uterovesical pouch
Answer: B
Tubal pregnancies
- commonly occur where the infundibulum narrows
to join the isthmus.
- Rupture of the tube almost invariably occurs with
severe intraperitoneal hemorrhage.
- The blood gravitates downward into the lowest
part of the peritoneal cavity (pouch of Douglas),
where it clots and forms a dough like mass that
can usually be felt through the posterior vaginal
wall. 9. The dorsal interossei muscles are innervated by the
A. deep branch of the radial nerve.
7. Which of the following produces flexion in the shoulder B. deep branch of the ulnar nerve.
joint: C. musculocutaneous nerve.
A. Anterior fibers of the deltoid, the pectoralis major, D. superficial branch of the ulnar nerve.
the biceps, and the coracobrachialis muscles. Answer: B
B. Middle fibers of the deltoid muscle, assisted by the
supraspinatus muscle. 10. An examination of a patient with carpal tunnel syndrome
C. Pectoralis major, latissimus dorsi, teres major and may reveal all the following symptoms and signs except
teres minor muscles. which?
D. Posterior fibers of the deltoid, the latissimus dorsi, A. Atrophy of the muscles of the thenar eminence
and the teres major muscles. B. Weakness in opposition of the thumb
Answer: A C. Loss of skin sensation on the medial part of the
- Flexion: Anterior fibers of the deltoid, the palm
pectoralis major, the biceps, and the D. Loss of skin sensation on the anterior surface of the
coracobrachialis muscles. index finger
- Extension: Posterior fibers of the deltoid, the Answer: C
latissimus dorsi, and the teres major muscles. Carpal tunnel syndrome
- Abduction: Middle fibers of the deltoid muscle, - results from compression of the median nerve
assisted by the supraspinatus muscle. as it passes beneath the flexor retinaculum.
- Adduction:Pectoralis major, latissimus dorsi, - The median nerve innervates the opponens
teres major, and teres minor muscles. pollicis muscle, and it gives off digital nerves to the
- Lateral rotation:Infraspinatus, teres minor, and lateral three and a half fingers on the palmar
posterior fibers of deltoid muscles. aspect.
- Medial rotation: Subscapularis, latissimus dorsi, - The muscles of the hypothenar eminence are
teres major, and anterior fibers of deltoid muscles. supplied by the deep branch of the ulnar
- Circumduction: A combination of all the nerve.
described movements. - The skin of the medial part of the palm is supplied
by the palmar cutaneous branch of the ulnar
8. Following muscles supplied by the musculocutaneous nerve.
nerve:
I. Biceps Brachii long head
II. Biceps Brachii short head
III. Triceps long head
IV. Triceps Medial Head
A. I,II,III
B. II, III
C. I,II
D. I, II, IV
Answer: C

5
MICROBIOLOGY AND PARASITOLOGY
Case1 (Nos. 1-3): Medical outreach physicians, working in a
refugee camp in central Africa, are concerned with the
number of young children presenting with high fever, bloody
diarrhea, and dehydration. The crowded living conditions of
the camp suggest person-to-person contact,but because of
the remoteness of the site only limited laboratory studies are
available. The suspected culprit is described as a nonmotile,
Gram-negative bacillus that does not produce lactose-
positive colonies on selective media.
1. Based on these findings, which disease is more
likely?
(A) Bacillary dysentery
(B) Campylobacteriosis
(C) Cholera (O:1 classic biotype)
(D) Nontyphoidal salmonellosis
(E) Staphylococcal food poisoning
Answer: A
Shigella dysenteriae
● a nonmotile, Gram-negative rod that does not
ferment lactose.
● Shigella species causing human disease include:
○ S. dysenteriae
○ S. flexneri
○ S. boydii
○ S. sonnei.
● Causes dysentery, a condition characterized by
the passage of numerous small bloody stools
containing mucus and pus.
● Humans are the only natural reservoir for
Shigella.
● The organism is spread by ingestion of fecal-
contaminated food or water.
● The infective dose is extremely low; as few as
200 bacteria can initiate the infection.
2. A major virulence factor of the etiologic agent in
the above question is a toxin. What is the role of
this toxin in disease production?
(A) Acts as a superantigen thereby inducing
inflammation
(B) Blocks protein synthesis causing intestinal cell
death
(C) Increases cAMP concentration within intestinal
cells
(D) Increases cGMP concentration within intestinal
cells
Answer: B
● Shiga toxin is an AB toxin; the gene for which is
carried on the chromosome of Shigella
dysenteriae.
● B portion of the toxin binds to the receptors on
intestinal cells and the A subunit enters the
cells and cleaves the 60 S subunit of the
ribosome, preventing the binding of transfer
RNA, thereby stopping protein synthesis. Intestinal
cells die, leading to bloody diarrhea and facilitating
the invasion of the organism into the lamina
propria.
3. What is the proper course of action the physicians
should take with regard to the management of the
outbreak described in the above case?
(A) Advise patients to increase their vitamin intake
due to the effects of diarrhea
(B) Avoid antibiotics and allow the symptoms
toabate naturally
(C) Avoid contact with animal reservoirs to prevent
reintroduction of the organism into the community
and prescribe antimotility drugs to reduce
transmission
D. Treat affected patients with antibiotics
Answer: D
● Antibiotic treatment decreases the duration of
illness and reduces person-to-person spread.
● Suitable antibiotics include ampicillin and TMP–
SMZ unless resistance is noted.
● If antibiotic susceptibility is unknown,
parenteral ceftriaxone sodium, a
fluoroquinolone, or azithromycin is the drug of
choice.
● Improved community sanitation and personal
hygiene should also be encouraged.
● Antimotility drugs are contraindicated for
patients with bloody diarrhea as they may prolong
the duration of fecal shedding of the organism
and increase the risk of bacteremia.
● Humans are the only host for Shigella; the
organisms have no animal reservoir.
Case 2(Nos 4-5) A 37-year-old man presented with a 2 day
history of low grade fever, abdominal cramps diarrhea,
nausea, and vomiting. One day prior to the onset of
symptoms, six family members had eaten at an all- you-can-
eat fried chicken buffet. Two other members of his famiily
(his 82-year-old mother and a 14-month-old son)
had similar symptoms. Examination of a fecal smear from
the patient revealed abundant fecal leukocytes.
4. Which of the following laboratory profiles is
consistent with the most likely microbial cause of
this man’s condition?
(A) Aerobic, β-hemolytic, spore-forming Gram- positive rod
(B) Bacitracin-sensitive, Gram-negative cocci
(C) Coagulase-negative, Gram-positive cocci
(D) Nonlactose fermenting, Gram-negative bacilli
Answer: D
- The two most common bacterial causes of
foodborne illness in the United States are
Campylobacter and Salmonella.
- Both are associated with undercooked
- poultry and cause invasive (inflammatory) GI
disease with the induction of fecal leukocytes.
- Salmonella are Gram-negative rods that are
unable to ferment lactose.
- Campylobacters are motile, curved, Gram-
negative rods that are isolated under
microaerophilic conditions (5% oxygen, 5% to
10% carbon dioxide) on selective media such as
Skirrow agar.
6
5. Which of the following medications, if taken by the man in
the above case, could have increased his susceptibility to
the infection he developed?
(A) Acetaminophen
(B) Antacids
(C) β-Blockers
(D) Ibuprofen
Answer: B
- Decreased gastric acid increases susceptibility to
GI disease caused by Salmonella and Vibrio
- The elderly and young children are also at an
increased risk of infection.
Case 3 (Nos. 6-7) : 34 A 16-year-old boy presented with a
1-week history of sore throat, fever, and profound fatigue.
Physical exam revealed a fever of 39.5 °C, cervical
lymphadenopathy, exudative pharyngitis, and mild
hepatosplenomegaly. His white blood cell count was
12,500/μL with 20% neutrophils, 24% monocytes, 42%
lymphocytes, and 12% atypical lymphocytes. A rapid
serologic test performed at the physician’s office revealed
the presence of heterophile antibodies.
6. What is the cause of this boy’s illness?
(A) Adenovirus
(B) Cytomegalovirus
(C) Enterovirus
(D) Epstein–Barr virus
Answer: D
● All the choices listed can cause pharyngitis
● Only Epstein– Barr virus (EBV) fits the entire
picture presented in the case.
● HIV can cause a similar clinical presentation as
well as atypical lymphocytes.
● Only EBV induced heterophil antibodies.
○ Heterophil antibodies are usually of the
IgM class and bind to red blood cells of
other mammals.
○ They are detectable during the acute
phase of infectious mononucleosis
caused by EBV.
● Following the acute illness, heterophil antibodies
rapidly decline in titer.
● Not all patients with EBV-associated
mononucleosis develop heterophile antibodies,
and for those cases, definitive diagnosis is made
by demonstrating IgM to viral capsid antigen.
7. Which cells infected by the virus in the above question
allow full virus replication and which may become
transformed by the virus?
(A) Lymph node dendritic cells and T cells, respectively
(B) Monocytes and cells of the oropharynx, respectively
(C) Monocytes and hepatocytes, respectively
(D) Nasopharyngeal epithelial cells and B cells, respectively
Answer: D
● EBV infects cells expressing CD21, also known
as complement receptor 2.
● B cells and epithelial cells of the upper
respiratory tract and parotid gland epithelial
cells express CD21.
● The virus produces a lytic infection with virus
production in epithelial cells, but is only semi
permissive in B cells.
● Semipermissive means that the virus can
replicate in only a small percentage of infected B
cells.
● B cells in which viral proteins are produced but
replication is not complete may be stimulated to
proliferate, and viral proteins may upregulate
expression of cellular genes involved in cytokine
secretion and prevention of apoptosis. These B
cells may become transformed.
● EBV is associated with B cell lymphomas
including those occurring in the central
nervous system of immunosuppressed
individuals, as well as Burkitt lymphoma and at
least some Hodgkin lymphomas.
8.Which of the following statements is NOT TRUE regarding
Croup
I. Croup occurs most commonly in children less than
3 years of age.
II. The symptoms, particularly the bark like cough
and the steeple sign.
III. Several respiratory viruses can cause croup;
however, the most common cause is a
parainfluenza virus (PIV 1, 2, or 3).
IV. A cause of cough in young children; however,
radiological findings are usually negative.
A. I,II,III
B. II, III
C. IV only
D. III,IV
Answer: C
9. Which of the following statements is true?
I. Genital herpes can be treated with acyclovir or
famciclovir or valacyclovir. The latter two drugs
have better oral bioavailability than acyclovir.
II. Imiquimod is used topically for the treatment of
genital and anal warts.
III. zanamivir is a neuraminidase inhibitor used to
treat influenza virus infections.
IV. Lamivudine is a nucleoside reverse transcriptase
inhibitor used for HIV and chronic hepatitis B virus
infections
A. I, II, III, IV
B. II, IV
C. I, II, III
D. III, IV
Answer: A
7
10. A 29-year-old pregnant nurse presents with a mono-
nucleolus like syndrome. She states that she had infec-
tious mononucleosis as a teenager, and is concerned
that she may have contracted cytomegalovirus from
her 18-month-old son who attends day care. Her con-
cern is for her unborn child. What is the incidence
of congenital cytomegalovirus infection in the United
States?
(A) 1/100,000 live births
(B) 1/10,000 live births
(C) 1/1,000 spontaneous abortions
(D) 1/100 live births
(E) 1/10 spontaneous abortions
Answer: D
● It is important for physicians to recognize the high
incidence of congenital cytomegalovirus (CMV)
infections in the United
● States.
● About 1% of infants born each year in the United
States are infected with CMV.
● Of these, only a minority (5% to 10%) will show
symptoms at birth.

References
Carroll, K. C., Butel, J. S., & Morse, S. A. (2019). Jawetz
Melnick & Adelbergs medical microbiology 28 E. McGraw
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Rodwell, V. W., Kennelly, P. J., Bender, D., Botham, K. M., &

Weil, P. A. (2018). Harper's illustrated biochemistry 31/E.
McGraw-Hill Education / Medical.

Snell, R. S. (2018). Snell’s clinical anatomy. Wolters kluwer

india Pvt.