240.

During the flooding that happened 34 days ago at the eastern coast of the United States; a
number of patients had taken ill with flood related transmissions of infectious diseases.
Epidemiologists decide to take a survey after the incident. Among the sample size; they noticed
that a few of the patients that had been admitted to the hospital had developed hepatomegaly
and splenomegaly over the course of the 30 days and had been readmitted with ascites.
Ultrasonography of these patients reveal echogenic periportal fibrosis with liver cirrhosis due to
pseudo tubercles. Which among the following best describes the clinical diagnosis of their
condition?

A. Cirrhosis associated immune dysfunction due to E.coli

B. Bilharziasis due to deposition of eggs of Schistosoma
C. Fulminant hepatitis due to delta virus infection
D. Amoebic colitis metastasizing to the liver
E. Tuberculous hepatitis due to granulomatous necrosis

241. A chest CT scan of a patient complaining of fever, chills and pleuritic chest pain with hemoptysis
shows the condition with air-crescentic sign indicating a late recovery with an increase in
neutrophilic infiltrations. The staining from the lung specimen reveals the structures of the
etiological agent shown in the right panel. Which of the following best describes the etiological
agent?

A. Aerogenic, filamentous acid fast bacilli

B. Segmented, brood capsulated tape-like hydatid worm
C. Cell wall lacking Mycoplasma pneumoniae
D. Dichotomously branching, angio-invasive Aspergillus spp.
E. Aseptate, coenocytic Zygomycetes

242. A 33 year old male was admitted to the hospital with seizures. MRI scans reveal,
hyperattennuated, calcified, ring-enhancing lesions of the brain that was diagnosed to be the
cause of his epileptic condition. Closer examination of the lesions on the scans show up as scolices
within the cysts. Which of the following could be the most probable mode or the cause for the
transmission of the causal agent?
 A. Bite of the reduvid bug indicating that the patient is from a low-income group
B. Traumatic injury to the head leading to a change in the redox potential of the brain
C. Pet cats that are infested with cat fleas that contaminate bitten sites on the skin
D. Ingestions of undercooked, measly pork with cysticerci
E. Ingestion of contaminated poultry, especially eggs

243. A 43 year old man was brought to the hospital with complaints of fever, vomiting and severe
headache. Clinical examination showed nuchal rigidity and photophobia. CSF analysis showed
lymphocytic pleiocytosis and based on the confirmation from the laboratory diagnosis;
amphotericin B was administered as a therapeutic regimen to the patient who started to show
signs of improvement with the treatment. What according to you could have been the test done
in order to have enabled the clinical diagnosis of the patient’s condition?

A. ZN staining showing acid-fast bacilli

B. Gram staining showing gram-positive diplococci
C. Mucicarmine staining revealing monomorphic, encapsulated yeast
D. Methanamine silver staining showing non-encapsulated yeast forms
E. Hematoxylin staining revealing tuberculate macroconidia

244. A 33-year old man with retro-positive condition with a CD4 count less than 100 cells/ul
was admitted with symptoms of severe chest pain and cough with hemoptysis. Chest
radiographic findings show hilar, lace-like infiltrates in the lung fields suggestive of atypical
pneumonia. Calcofluor white stain of his broncho-alveolar lavage shows cysts that resemble
crushed ping-pong balls Which of the following could be the most probable etiological agent?

A. Histoplasma capsulatum
B. Aspergillus flavus
C. Paragonimus westermani
D. Entamoeba histolytica
E. Pneumocystis jiroveci

A 6 month old infant was brought to the Paediatrician due to complaints of severe recurrent
pyogenic infections as shown above. Immunologic parameters including lymphocyte subsets and
immunoglobulins were within normal range. Tumor markers including alpha-fetoprotein and ß-
HCG were negative. The etiological agent causing the lesions on his skin were identified as
Staphylococcus aureus. Which among the following could be the most probable, underlying
condition in the infant predisposing him to recurrent infections?
 A. Severe combined autosomal inheritance of immunodeficiency
B. Bruton’s disease due to agammaglobulinemia and lack of circulating B cells
C. Chronic granulomatous disease due to loss of function mutation of NADPH oxidase
D. Wegener’s granulomatosis with polyangiitis due to autoantibodies
E. Granulomatous infiltrations due to atypical opportunistic pathogen as a co-infection

245. A 23 year old consulted her gynaecologist as she was suffering from lower back pain. She also
complained of burning micturition. Greiss-nitrate test being positive; her urine specimen was
sent for further microbiological analysis which revealed that the etiological agent was
Enterococcus faecalis. She was treated with Ampicillin for 5 days after which she recovered.
Which among the following best describe the Gram’s reaction of the etiological agent?

F. Gram variable bacilli

G. Gram negative rods
H. Gram positive diplococci
I. Gram positive streptobacilli
J. Gram negative, capsulated diplococci

246. If this was the photomicrograph that was obtained from the stool of an HIV retropositive patient
with a CD4 cell count < 100 cells/ml. The stool specimen showed the oocysts of a coccidian
parasite as shown which was the cause for his clinical manifestation of protractile diarrhoea.
Which among the following could be the most probable etiological agent in the retropositive
patient?
 A. Non-acid fast Pneumocystis jiroveci
B. Acid fast Isospora belli
C. Acid fast Mycobacterium smegmatis
D. Acid fast Cryptosporidium parvum
E. Gram variable Microsporidium spp.

247. A 16 year old male was admitted with symptoms of nuchal rigidity, vomiting and dizzy spells with
photophobia. Kernig’s sign was positive. CSF analysis showed that the organism was a gram
negative diplococcus that was capsulated. Retrospective clinical history revealed that the patient
has had two other episodes of this infection a month before and 6 months prior. His brother also
seemed to have had the same recurrent infection with the same pathogen 3 months before.
What according to you could be the most probable reasons behind this recurrent infection in the
brothers?

F. Lack of decay accelerating factor of the complement

G. Genetic disorder that causes excessive stimulation of C1q activation
H. Immune deficiency of C1q esterase
I. Hypogammaglobulinemia due to Btk genetic mutation
J. Deficiency of the terminal complement components of C5-C8

248. A child hailing from Gujarat in India showed symptoms of vesicular lesions starting from the face
moving downwards to the trunk and the extremities. The fluid-filled vesicles were seen as crops
on the skin. What according to you should the immune mediated attack entail if the etiological
agent in this case is a virus?

A. Stimulation through IL-2 activating CD8+T cells with MHC I antigen presentation
B. Outpouring of IL-1, IL-6 and TNF-alpha through super antigen effect
C. Activation of B cells through IgM BCRs triggering the release of IL-4 and IL-5
D. Stimulation of Humoral immunity through IL- 1 and IL-4
E. Activation of CMI through IL-12 and IFN-gamma with MHC II antigen presentation

249. A young woman aged 22 years was admitted to the hospital due to syncope. On clinical
examination, her mean arterial pressure was <65mm of Hg with a fall in systolic blood pressure
>40mm of Hg. Her hands were cold and clammy to the touch indicating that she was in a state of
shock. Blood cultures and her tampon culture revealed Staphylococcus aureus to be the etiology
for the sepsis. Which of the following best describes the underlying immunological mechanism
that is mediated in this patient?

A. CMI through Il-2 and CD8 cells

B. HMI through IL-4/5 and CD4 cells
C. ADCC through NK cells CD56 bright/CD16 dim
D. Cytokine storm through antigen binding at Vβ of the TCR
E. Opsonization and complement activation through C4 complement component