TROPICAL INFECTION QUESTIONS’ SHEET

SEMIFINAL SES OF
4th INDONESIAN INTERNATIONAL MEDICAL OLYMPIAD

Medical Faculty of Hasanuddin University | Oct, 16th 2015

1. A 3-year-old boy was brought to the hospital by his mother. He has vesicles with
eritematous base on his face, scalp, trunks and extremities for the past 2 days. He also
has a history of fever 1 day before the skin lesions appear. The mother told you that the
elder brother of the boy has a history of the same disease 2 weeks ago, but the disease
was less severe than the younger brother has. You finally decide to give the boy
acyclovir. Which of the following statements concerning treatment with acyclovir is
correct?
A. If the boy is immunocompromized, acyclovir should not be given
B. If the boy is immuocompetent, acyclovir may shorten the duration of the disease
C. If the boy is immunocompetent, acyclovir may enhance the immuno response to the
pathogen
D. Acyclovir should be given 80 mg/kg body weight 5 times a day
E. Acyclovir should be given for at least 10 days

2. A 7-year-old boy complaints of intermittent fever for the past 3 days, malaise, without
chills. He also experiences discomfort on the upper abdomen. Physical examination
reveals the body temperature of 37,80C, blood pressure of 100/70 mmHg and pulse
100x/min. Rumple leede test was positive. Laboratory examination reveals : Hb =: 13.8
g/dl,, Trombocyte= 110.000 / µl . Leukocyte = 2300 / µl, Hematocrite = 50%. Which of
the following test is MOST likely done to confirm the diagnosis ?
A. Widal test
B. HBsAg test
C. NS1Antigen test
D. Rapid ICT Malaria test
E. IgM and IgG Dengue test

3. Your patient is a 27-year-old man with fever for the past 8 days. He told you that his
body temperature seems to be higher in the afternoon. He also complaints of diarrhea.
Physical examination reveals body temperature of 38,2C, and pulse 84x/min, and coated
tounge. Which of the following laboratory test is MOST likely done to confirm the
diagnosis?
A. Widal test
B. IgM Dengue
C. Stool examination
D. Thick blood smear
E. Acid-fast bacillus test

4. A 45-year-old man complaints of upper abdominal pain, headache, joint pain, nausea and
vomiting. He works as a public servant in the ministry of forestry. Laboratory
examination reveals LED : 60 /85 mm/hour. GDS : 122 mg/dl, Blood Ureum : 56,5
mg/dl., blood creatinin : 2,44 mg/dl. SGOT : 83 U/l. SGPT : 86 U/l. Laboratory
examination of urinary sediment reveals hematuria. Which of the following laboratory
test is MOST likely done to confirm the diagnosis?
 A. HBsAg test
B. IgM Typhi
C. IgG Malaria
D. ICT Leptospirosis
E. ICT Helicobacter Pylori

5. Your patient is a 25-year-old man with coughing for the past 1 year. In the last 2 months
he experienced body weight loss for 9 kgs. He also experienced intermittent fever and
diarrhea in the last 3 weeks. Careful history taking reveals he has coughed up blood in
the past 2 weeks and has been a drug user for 5 years. Blood count examination reveals
leukocytes of 3000/mm3 and lymphocyte of 3%. The sputum was positive for acid-fast
bacilli. Which of the following confirmatory laboratory test should be done?
A. ICT Malaria test
B. HBsAg test
C. IgM Typhi
D. ICT anti HIV
E. ICT Leptospirosis

6. Your patient is a 25-year-old woman who often experiences fever, coughing and diarrhea
in the past 3 weeks. She also lost her weight for 8 kgs in short time. From the history
taking, you found that her husband is an injected drug user. Which of the following test
is the gold standard to confirm the diagnosis of the woman disease
A. PCR
B. Rapid test
C. ELISA
D. Western Blot
E. Haemaglutination tes

7. A 5-year-old girl complains of an earache for the past 2 days. On examination, she has a
temperature of 390C, the right external canal contained dried blood, the drum was
perforated, and a small amount of purulent fluid was seen. Gram stain of the pus revelead
gram-positive diplococci. Colonies formed green hemolysis on blood agar. Growth was
inhibited by optochin. What is the MOST likely pathogen ?
A. Streptococcus pneumonia
B. Staphylococcus aureus
C. Haemophilus influenza
D. Corynebacterium diphtheriae
E. Neisseria meningitidis

8. A 40-year-old woman was well until 2 days ago, when she experienced the sudden onset
of fever, shaking chills, and profuse sweating. Today, she presented to the hospital with
altered conciousness. There was history of generalized tonic clonic convulsions prior to
admission. Travel history reveals she returned from an extended trip to several countries
in Central Africa 1 week ago. What is the MOST likely finding in her blood smear?
A. Amoeboid-shaped trophozoite
B. Rosette-shaped schizont
C. Banana-shaped gametocyte
D. Large erythrocyte with fimbriated end
E. Small erythrocytes
9. A 20-year-old man complains of several episodes of blood in his urine. He has no
dysuria or urethral discharge. He is not sexually active. He is a college student in the
USA but was born and raised in Egypt. Physical examination reveals no penile lesion.
Urinalysis shows many red cells, no white cells, and several large eggs with terminal
spines. What is the most likely cause of the disease?
A. Shistosoma japonicum
B. Schistosoma haematobium
C. Schistosoma mansoni
D. Trichomonas vaginalis
E. Toxoplasma gondii

10. A 20-year-old woman in her 30th week of pregnancy had an ultrasound examination that
revealed a growth-retarded fetus with a large head (indicating hydrocephalus) and
calcifications within the brain. Umbilical blood was cultured and crescent-shaped
trophozoites were grown. What is the most likely cause of the disease?
A. Trichomonas vaginalis
B. Cytomegalovirus
C. Toxoplasma gondii
D. Treponema pallidum
E. Epstein Barr virus

11. A 40-year-old woman has just had gr and mal seizure. There is a history of headaches for
the past week and one episode of vertigo but no previous seizures. She is afebrile. She is
a native of Honduras but has lived in The USA for the past 5 years. MRI reveals a mass
in the parietal lobe. Surgical removal of the mass reveals a larva within a cystlike sac.
What is the most likely cause of the disease?
A. Taenia solium
B. Taenia saginata
C. Strongyloides stercoralis
D. Ancylostoma duodenale
E. Trichinella spiralis

12. An outbreak of sepsis caused by Staphylococcus aureus has occurred in th newborn

nursery. You are called upon to investigate. According to your knowledge of th normal
flora, what is the most likely source of the organism?
A. Colon
B. Nose
C. Throat
D. Vagina
E. Skin

13. Your patient is 5-year-old boy with fever and a swollen in his left cheek. You suspected
him as having mumps. Each of the following statement concerning the disease is correct
EXCEPT :
A. Mumps virus is a paramyxovirus and hence has a single-stranded RNA genome
B. Meningitis is a recognized complication of mumps
C. Mumps orchitis in children prior to puberty often causes sterility
D. During mumps, the virus spreads through the bood-stream (viremia) to various
internal organs
E. The most common form of mumps is parotitis
14. Your patient is a 50-year-old man with chief complaints of right upper abdominal pain
with high grade fever. You suspected him as having amoebiasis and will do laboratory
examination. Laboratory diagnosis of a patient with a suspected liver abscess due to
Entamoeba histolytica should include :
A. Stool examination and indirect hemagglutination test
B. Stool examination and blood smear
C. Indirect hemaglutination test and skin test
D. Xenodiagnosis and string test
E. String test and blood smear

15. Each of the following statements concerning Toxoplasma gondii is correct ECXCEPT ;
A. T . gondii can be transmitted across the placenta to the fetus
B. T gondii can be transmitted through blood transfusion
C. T gondii can be transmitted by cat feces
D. T gondii can cause encephalitis in immunocompromised patients
E. T gondii can be diagnosed by finding trophozoites in the stool

16. A 40-year- old man complaints of watery, foul-smelling diarrhea and flatulence for the
past 2 weeks. He drank untreated water on a camping trip about a month ago. Pear-
shaped flagellated trophozoites were seen in stool. Each of the following statement
concerning the pathogen is correct EXCEPT :
A. It has both a trophozoite and a cyst stage in its life cycle
B. It is transmitted by the fecal-oral route from both human and animal sources
C. It causes haemolytic anemia
D. It can be diagnosed by the string test
E. Its main habitat is duodenum

17. A 40-year-old woman was well until 2 days ago, when she experienced the sudden onset
of fever, shaking chills, and profuse sweating. Today, she also complains of headache
and abdominal pain but no nausea, vomiting or diarrhoea. Travel history reveals she
returned from an extended trip to several countries in Central Africa 1 week ago. Each of
the following statements concerning the suspected disease is correct EXCEPT :
A. The female Anopheles mosquito is the vector
B. Early in infection, sporozoites enter hepat ocytes
C. Release of merozoites from red blood cells causes periodic fever and chills
D. The principal site of gametocyte formation is the human gastrointestinal tract
E. Sexual development occurs in Anopheles mosquito

18. Your patient is a 25-year-old woman with complaints of a smelly, yellow vaginal
discharge and slight dysuria for one week. You suspected her as being infected by
Trichomonas vaginalis. Each of the following statements concerning the pathogen is
correct EXCEPT :
A. T vaginalis is transmitted sexually
B. T vaginalis can be diagnosed by visualizing the trophozoite
C. T vaginalis can be treated effectively with metronidazole
D. T vaginalis actively move with cilia
E. T vaginalis consists of only one cell
19. Your patient is a 20-year-old woman with sudden onset of fever to 40 0C and a severe
headache. Physical examination reveals nuchal rigidity. You suspect meningitis and do a
spinal tap. Gram stain of the spinal fluid reveals many neutrophils and many gram-
negative diplococci. Of the following bacteria, which one is the MOST likely to be the
cause?
A. Haemophilus influenza
B. Neisseria meningitidis
C. Streptococcus penumoniae
D. Pseudomonas aeruginosa
E. Klebsiella penumoniae

20. Your patient is a 50-year -old woman who returned yesterday from a vacation in Peru,
where there is an epidemic of cholera. She now has multiple episodes of diarrhea. Of the
following, which one is the MOST compatible with cholera.
A. Watery diarrhea without blood, no polys in the stool, and growth of curved gram-
negative rods in the blood culture
B. Watery diarrhea without blood, no polys in the stool, and no organism in th blood
culture
C. Bloody diarrhea, polys in the stool, and growth of curved gram-negative rods in the
blood culture
D. Bloody diarrhea, polys in the stool, and no organism in the blood culture
E. Steatorrhea, and moving trophozoites in fecal examination

21. Your patient is a 40-year- old man with a history of confusion for the past 2 days and a
grand-mal seizure that occurred this morning. He is HIV antibody-positive and has a
CD4 count of 100/µL. On examination his temeperature is 37.5 0C and the findings of the
remainder of the examination are within normal limits. An MRI reveals several “ring-
enhancing-cavitary “ brain lesions. He is employed as the manager of a supermarket, is a
strict vegetarian, and has several household pets, namely, a dog, a cat, a parrot, and a
turtle. Which one of the following organism the MOST likely cause?
A. Toxocara canis
B. Toxoplasma gondii
C. Taenia saginata
D. Trichinella spiralis
E. Trypanozoma cruzii

22. A 50-year-old man has had low-grade, persistent headaches for several months. In the
last few days, nausea, vomiting, and blurred vision have occurred. An MRI reveals
several cystlike lesions in the brain parenchyma. The patient lived for many years on one
of the small Caribbean islands. On the basis of a positive serologic test, a diagnosis of
neurocysticercosis was made. Of the following, which one is the MOST likely mode by
which the disease was acquired?
A. Ingestion of the larvae of the organism in raw fish
B. Ingestion of the eggs of the organism in contaminated food
C. Penetration of the skin by the organism while walking bare-footed
D. Penetration of the skin by the organism while bathing in fresh water
E. Sexual intercourse

23. A 30-yeaar-old woman with a previous history of rheumatic fever now has a fever for the
past 2 weeks. Physical examination reeals a new heart murmur. You suspect endocarditis
 and do a blood culture, which grows a viridians group streptococcus later identified as
Streptococcus sanguis. Of the following body site, which one is the MOST likely source
of this organism?
A. Colon
B. Mouth
C. Skin
D. Stomach
E. Vagina

24. Which of the following statements regarding disease associated with influenza virus
infection is/are FALSE?
A. Influenza virus infection of respiratory epithelial cells results interaction of those
cells.
B. Systemic manifestations of influenza virus infection (e.g. fever, myalgia, headache)
arise from the presence of virus circulating in the bloodstream.
C. Pneumonia arising as a complication of influenza virus infection is usually due to
secondary bacterial invasion.
D. Influenza-related mortality is higher in patients with pre-existing cardiac disease.
E. Influenza-related encephalitis arises through crossreactivity of the immune response
to infection with the patient’s brain tissue.

25. Which of the following statements regarding the avian H5N1 influenza virus are
FALSE?
A. Infection of humans results in death over 50% of cases.
B. The pathogenesis of disease arises from explosive release of cytokines within the
respiratory tract.
C. Infection can be prevented by vaccination with vaccines containing antigens derived
from A/H1N1 and A/H3N2 viruses.
D. This virus is always resistance to oseltamivir.
E. This virus is a possible candidate for the next influenza pandemic.

26. Which of the following statements regarding diagnostic tests is/are true?
A. Virus isolation in cell culture is a rapid diagnostic technique.
B. Antigen detection techniques are dependent on the presence of viable virus in the
sample sent to the laboratory.
C. Genome detection techniques are the most sensitive assays for diagnosis of virus
infections.
D. Genome amplification assays cannot be used for RNA viruses.
E. Demonstration of high antibody titers to the H5 hemagglutinin in serum samples
taken from acutely ill patients will be the mainstay of diagnosis of human infection
with avian H5N1 influenza virus.

27. Which of the following drugs has proven efficacy against influenza A viruses?
A. Aciclovir.
B. Foscarnet.
C. Indinavir.
D. Zanamavir.
E. Zidovudine.
28. With regard to anti-influenza drugs, which of the following statements are true?
A. Amantadine is effective as a prophylactic agent against influenza B virus.
B. The mode of action of amantadine involves blockage of an ion channel and
prevention ofviral uncoating.
C. Neuraminidase inhibitors have no activity against influenza B virus.
D. Resistance to oseltamivir has not been described in influenza A viruses.
E. Zanamavir should not be used in patients with a history of egg allergy.

29. With regard to influenza vaccines, which of the following statements are true?
A. Vaccine-induced immunity is clinically useful for at least 10 years.
B. Universal vaccination against influenza is currently recommended.
C. Inactivated influenza vaccines are contraindicated in immunosuppressed individuals.
D. Influenza vaccines contain antigens derived from A/H1N1, A/H3N2, and B viruses.
E. Live attenuated influenza vaccines are administered by subcutaneous injection.

30. Which of the following are true about the causative agent of leishmaniasis, EXCEPT?
A. The extracellular form of leishmania is called the amastigote.
B. Leishmania can be taxonomically subdivided by isoenzyme typing.
C. The form of clinical disease can depend on the species of Leishmania.
D. There are both animal and human reservoirs of infection.
E. Spread within the body occurs inside macrophages.

31. Which of the following are FALSE of the transmission of leishmaniasis?

A. The domestic dog can serve as a reservoir of infection.
B. The insect vector is the sandfly.
C. The infective form when the vector bites a new host is the amastigote.
D. Infection can be transmitted between intravenous drug users with shared needles and
equipment.
E. Individuals with post kala-azar dermal leishmaniasis (PKDL) can serve as a human
reservoir of infection.

32. Which of the following are FALSE of the host response to leishmaniasis?
A. A Th1 response is associated with susceptibility.
B. Interferon-g activates macrophage to increase leishmanicidal functions.
C. In different strains of mice infected with L. major there is either a Th1 or Th2
response.
D. Neutrophils fail to kill phagocytosed Leishmania.
E. A granulomatous inflammatory response develops in tissues.

33. Which of the following are FALSE of the pathogenesis of leishmaniasis?

A. Leishmania may enter macrophages in apoptotic neutrophil fragments.
B. Leishmania are susceptible to lysosomal attack.
C. Leishmania homolog of activated C kinase receptor (LACK) steers the host to a Th2
response.
D. Dendritic cell antigen presentation is down-regulated by Leishmania.
E. Leishmania suppresses the production of reactive oxygen and nitrogen intermediates.

34. Which of the following are true of cutaneous and mucocutaneous leishmaniasis?
A. Cutaneous lesions are usually found in moist areas such as the armpit and groins.
B. Lesions are manifest 2–6 days after a bite.
 C. Lesions are always painful.
D. L. braziliensis and L. panamensis are the key species responsible for mucocutaneous
disease.
E. In mucocutaneous disease the mucosal lesions appear in fewdays after an initial
cutaneous lesion.

35. Which of the following are FALSE of the diagnosis of leishmaniasis?

A. Mucocutaneous disease can be diagnosed clinically in endemic areas.
B. On staining tissue samples the characteristic appearance of the organism is called
Donovan bodies.
C. The sensitivity of splenic aspirates is about 90%.
D. PCR has a high sensitivity and specificity.
E. Serological tests can distinguish recent acute infection from past infection.

36. Which of the following are FALSE of the differential diagnosis of leishmaniasis?
A. Cutaneous tuberculosis may cause similar cutaneous lesions.
B. Mucocutaneous leishmaniasis is the only infection that destroys the nasal septum.
C. Visceral leishmaniasis may have to be differentiated from malaria.
D. Clinical features alone are sufficient to differentiate visceral leishmaniasis from other
diagnoses.
E. Noninfectious diseases can cause fever like visceral leishmaniasis.

37. Which of the following are true of the treatment of leishmaniasis?

A. All cutaneous lesions need to be treated to prevent disease progression.
B. All treatments are parenteral (i.e. need to be given by injection).
C. Treatment courses can last up to 28 days.
D. Amphycillin can be used to treat visceral leishmaniasis.
E. Miltefosine is less effective than other treatments for visceral leishmaniasis.

38. Which of the following are true of the control and prevention of leishmaniasis?
A. Mosquito nets are sufficient to prevent sandfly bites.
B. The distribution of mosquito nets to control malaria has reduced the incidence of
leishmaniasis.
C. Sandflies are intrinsically resistant to pyrethroid insecticides.
D. There is no effective vaccine to date.
E. Treatment of individuals with post kala-azar dermal leishmaniasis is sufficient to
eliminate the reservoir of infection.

39. A 24-year-old sexually active woman sees a doctor with complaints intense vaginal
itching and burning on urination. Her pelvic examination reveals the presence of a frothy
vaginal discharge, which has a musty odor. Her cervix is friable with diffuse
inflammation. A wet mount of the vaginal discharge is examined and reveals oval
trophozoites that exhibit jerky movement. Which organism is most likely responsible for
her infection?
A. Cryptosporidium sp.
B. Cyclospora sp.
C. Entamoeba sp.
D. Giardia sp.
E. Trichomonas sp.
40. A-60 year-old man is taken by his family to emergency department of a local hospital
with complaints an upper quadrant, pain, nausea, and vomiting. History reveals that the
man raised sheep. Abdomen CT scan reveals a large mass in his liver (hydatid cyst).
Which organism is most likely responsible for his infection?
A. Dhyphillobothrium latum
B. Echinococcus granulosus
C. Hymenolepis nana
D. Taenia solium
E. Taenia saginata

41. A 30-year-old man sees a doctor in primary care with complaints a mild gastrointestinal
symptom. He is asked to provide a stool sample for evaluation. An examination of the
stool indicates the presence of proglottids with intricate pattern of 28 uterine branches.
Upon further questioning, the man admits to regularly eating raw hamburger. Which
organism is most likely responsible for his infection?
A. Dhyphillobothrium latum
B. Echinococcus granulosus
C. Hymenolepis nana
D. Taenia solium
E. Taenia saginata

42. A 30-year-old man presents emergency department of a local hospital with complaints
nausea, vomiting, and watery diarrhea that contains blood and mucus. His stool sample is
collected and sent to the laboratory for ova and parasite examination. Microscopic
examination of a saline wet mount reveals the presence of large ciliated trophozoites,
Contractile food vacuoles Cytostome at anterior, and cytopyge at posterior. Which
organism is most likely responsible for his infection?
A. Balantidium coli
B. Cryptosporidium parvum
C. Entamoeba coli
D. Entamoeba dispar
E. Entamoeba histolytica

43. A 13-year-old boy is taken to primary health care because he exhibits an abdominal
cramps, watery diarrhea, flatulence, and steatorrhea. His symptoms have been exhibited
since one week ago. History reveals that the boy drank water from a mountain stream
without boiling. A stool sample is collected and sent to the laboratory for testing. Direct
examination reveals pear-shaped trophozoites with two nuclei. Which organism is most
likely responsible for his infection?
A. Cryptosporidium sp.
B. Cyclospora sp.
C. Entamoeba sp.
D. Giardia sp.
E. Trichomonas sp.
44. A 2-year-old girl is taken to a primary health care because she has been having trouble
sleeping because of intense perianal itching. The doctor instructs the mother to obtain a
perianal specimen that night using an applicator covered with transparent scotch tape
sticky side out. The specimen is examined microscopically, revealing an asymmetrical
transparent eggshell, elongated oval and flattened on one side. Which organism is most
likely responsible for this patient’s symptoms?
A. Ascaris lumbricoides
B. Enterebius vermicularis
C. Necator americanus
D. Toxocara cani
E. Trichuris trichiura

45. A 7-year-old girl is taken to the doctor with complaints an abdominal cramps, bloody
diarrhea with mucus, and tenesmus. A blood sample reveals the girl is anemic. A stool
culture is negative for shigella; however, direct examination of the stool reveals the
presence of barrel-shaped eggs with a plug on each end. Which organism is most likely
responsible for this patient’s symptoms?
A. Ascaris lumbricoides
B. Enterebius vermicularis
C. Necator americanus
D. Toxocara cani
E. Trichuris trichiura

46. A 30-year-old man presents to a clinic with multiple fibrous subcutaneous nodules on his
lower torso, pelvis, and lower extremities. He complains that he cannot see very well and
his eyes are sensitive to sunlight. A slit-lamp examination of the anterior chamber of the
man’s eyes reveals the presence of motile microfilariae. Which organism is most likely
responsible for his infection?
A. Brugia malayi
B. Brugia timori
C. Loa-loa
D. Onchocerca volvulus
E. Wuchereria bancrofti

47. A 23-year old man returns from a camping trip. He presents to the emergency
department suffering from abdominal pain, nausea, fever and bloody diarrhea. Stool
examination with trichrome-staining reveals an organism with size 10-20 µm, round
shape containing 4 nuclei and chromatoidal body. Which organism is most likely
responsible for his infection?
A. Acanthamoeba sp.
B. Dientamoeba sp.
C. Entamoeba sp.
D. Giardia lamblia
E. Isospora sp.

48. A 45 year-old man with acute myelogenous leukemia is seen by his medical oncologist
because of prolonged neutropenia and fever that developed after chemotherapy despite
 broad spectrum antimicrobial therapy. One week later, he had an episode of hemoptysis.
Biopsy of one of the lesions showed septate hyphae, and laboratory test result for
galactomannan antigen were positive. Which organism is most likely responsible for his
infection?
A. Aspergillosis sp
B. Candida sp.
C. Cryptococcus sp.
D. Histoplasma sp.
E. Fusarium sp.

49. A 15-year-old boy complains of extreme fatigue and is found to have swollen glands,
hepatomegaly, splenomegaly and positive results in the test for heterophile antibody.
Which activivity is associated with the agent responsible for these findings?
A. Activation of unrelated antibody production
B. Binding of erythrocytes to infected cell surfaces
C. Continued release of surface antigen
D. Expression of characteristic inclusion bodies
E. Integration of cDNA into host chromatin

50. A 4-year-old girl is brought to the emergency department because of a continuous, loud,
barking cough and difficulty catching her breathe. Her breathing improves in the
presence of humidified air. A virus isolated from a nasal wash. The virus causes
hemagglutination and promotes syncytia formation in cell culture. Which virus is most
likely cause of this patients’s condition?
A. Parvovirus
B. Reovirus
C. Rhinovirus
D. Parainfluenza virus
E. Influenza virus

51. A 26-year-old woman in her second trimester of pregnancy arthristic symptoms and a
maculopapular rash on her trunk. Serologic tests are negative for igM antibodies to
parvovirus B19 and measles virus but the tests are positive for igM antibodies to rubella
virus and for IgG antibodies to measles and rubella viruses. Which condition is the
highest risk for this infant?
A. Cerebral calcification
B. Chorioretinitis
C. Deafness
D. Hydrops fetalis
E. Keratoconjunctivitis

52. A 22-year-old man who works in the pediatric ward of a hospital suffers from malaise,
sneezing, and a runny nose, but the does not have a fever. He subsequently develops a
mild sore throat, headache, and stuffy nose. The symptoms resolve within 4 days. Which
virus is most likely to be responsible for these symptoms?
A. Corona virus
B. Hantavirus
C. Norwalk virus
D. Rubella virus
 E. Vesicula stomatitis virus

53. A 9-year-old boy is carried into the emergency department suffering from bilateral
paralysis. His parents report that he started experiencing flu-like symptoms
approximately 2 weeks earlier. Recently, he had a high fever and began to complain of
muscle pain and a stiff neck. The boy did not reveive the normal course of childhood
immunizations. What is the most likely route of infection
A. Arthropoda bite
B. Contact with lesions of an infected individual
C. Fecal-oral route
D. Parenteral route
E. Respiratory route

Vignette for No 54-55

A 5 year-old man visits community health center with a maculopapular rash that started on
his head and spread to his trunk; the rash is accompanied by fever, cough, coryza and
conjunctivitis.

54. Which immune response that involved in this case?

A. Ig A
B. Ig E
C. IgG
D. T-cells
E. Neutrophils

55. How is the disease dominantly transmitted?

A. Blood
B. Saliva
C. Mosquitoes
D. Sexual contact
E. Respiratory droplets

56. A 50-year-old man undergoing a routine physical examination complains of fatigue, an

inability to concentrate, and epigastric pain that has gotten worse during the past year.
His medical records show that he receive a blood transfusion during surgery in the late
1980s. His blood contains elevated transaminase levels. A PCR-based blood test for
flavivirus sequences yields positive results. Which virus is the most likely diagnosis?
A. HAV
B. HBV
C. HCV X
D. HDV
E. HEV

57. A 1-month-old breast fed infant is exposed to HAV. The mother has been seropositive
for this virus for several years. Which type of antibody most likely to provide protection
for the infant?
A. IgA
B. IgD
C. IgE
D. IgG
 E. IgM

58. Which of the following are FALSE for disease caused by Leptospira?
A. Vasculitis is a common occurrence.
B. Pulmonary hemorrhages are frequent.
C. Acute tubular necrosis may occur.
D. It is a granulomatous disease.
E. Thrombocytopenia is common.

59. Which of the following are true of the clinical presentation of leptospirosis, EXCEPT?
A. All infection presents in the same fashion.
B. Any serovar can cause any clinical presentation.
C. Leptospirosis is a biphasic illness.
D. Leptospirosis may be confused with Legionnaires disease, viral hepatitis or
Hantavirus infection.
E. Jaundice and renal failure with conjunctival inflammation is a common presentation
with L. interrogans serovar Icterohaemorrhagiae.

60. Which of the following are useful in the diagnosis of leptospirosis, EXCEPT?
A. Gram stain.
B. Culture.
C. Microscopic agglutination test.
D. IgM ELISA.
E. PCR.

61. Which of the following are characteristic of the physiology of M. leprae?

A. Rapid growth.
B. A requirement of 37∞C for optimal growth.
C. Being disseminated through the digestive route.
D. Its growth inside macrophages and Schwann cells.
E. Its preference for growth in the peritoneal cavity.

62. Which of the following characterize the tuberculoid (TT) form of leprosy, except?
A. The prevalence of the production of Th1 over Th2 cytokines.
B. The predominantly T-cell-mediated immune responses.
C. The development of erythema nodosum leprosum (ENL).
D. A possibility of a spontaneous resolution.
E. Belonging to the paucibacillary form of leprosy.

63. Which of the following characterize the lepromatous form (LL) of leprosy, except?
A. The prevalence of the production of Th2 cytokines IL-4, IL-5, and IL-10.
B. Predominantly antibody-mediated immune responses.
C. The possibility to revert to the less severe form.
D. Belonging to the multibacillary form of leprosy.
E. More than five skin lesions.

64. A 24-year old sexually active female presents with dysuria (pain on urination) and
cervical discharge. Gram stain of the cervical discharge reveals gramnegative diplococci
in pairs. Which one of the following would be the most appropriate therapy to initiate?
A. Penicillin.
 B. Erythromycin.
C. Ceftriaxone.
D. Ceftriaxone plus doxycycline.
E. Ampicillin.

65. The process of phase and antigenic variation in gonococci involves?

A. Lysogeny by a bacteriophage.
B. Plasmid transfer.
C. Genetic recombination.
D. Sex pili.
E. Transduction

66. A young army recruit presents at a sexually transmitted disease (STD) clinic with acute
urethritis. A Gram stain of his urethral exudate reveals neutrophils with intracellular
gram-negative diplococci. He is treated with ceftriaxone and sent home. He is requested
to return in 1 week so that a urethral culture can be obtained to confirm antibiotic cure.
Which ONE of the following culture media should be used for the follow-up culture?
A. Blood agar.
B. Chocolate agar.
C. MacConkey agar.
D. Modified Thayer-Martin agar.
E. Mannitol-salt agar.

67. 4. A 24-year-old sexually active female presents with dysuria and a purulent discharge
from the cervical canal. A Gram stain of the discharge shows the presence of gram-
negative diplococci and numerous neutrophils. The lab reports the isolation of
nonhemolytic, gram-negative, oxidase-positive diplococci that utilize glucose. A deletion
of the genes responsible for the synthesis of which one of the following would make the
organism unable to initially attach to male urethral epithelial cells and endocervical
cells?
A. Capsular polysaccharide.
B. C-carbohydrate.
C. O side-chain of lipooligsaccharide.
D. Pili.
E. Spore coat protein.

68. A 22-year-old sexually active female from New England presents with fever and right
knee swelling. Her joint aspirate reveals gram-negative diplococci. She also has had a
recent bout of cervicitis. What is the most likely cause of this patient’s septic arthritis?
A. Staphylococcus aureus.
B. Streptococcus pyogenes.
C. Neisseria gonorrhoeae.
D. Pseudomonas aeruginosa.
E. Borrelia burgdorferi.

69. A 16-year-old female comes to the physician because of an increased vaginal discharge.
She developed this symptom 2 days ago. She also complains of dysuria. She is sexually
active with one partner and uses condoms intermittently. Examination reveals some
erythema of the cervix but is otherwise unremarkable. A urinalysis is negative. Sexually
transmitted disease testing is performed and the patient is found to have gonorrhea.
 While treating this patient’s gonorrhea infection, treatment must also be given for which
one of the following?
A. Bacterial vaginosis.
B. Chlamydia.
C. Herpes.
D. Syphilis.
E. Trichomoniasis.

70. All of the following are important in the isolation and laboratory diagnosis of Neisseria
gonorrhoeae infections, EXCEPT?
A. Use of selective culture media to suppress the growth of other bacteria and fungi
while allowing gonococci to grow.
B. Positive oxidase test.
C. The ability of the gonococcus to use only glucose out of the four sugars tested on an
acid production panel.
D. The presence of intracellular gram-negative cocci in penile discharge.
E. Detection of IgM antibody to pili by ELISA.

71. Neisseria gonorrhoeae is capable of all of the following,EXCEPT?

A. Aerobic metabolism.
B. Cleavage of secretory immunoglobulin A subclass 1 (sIgA1).
C. Transcytosis of epithelial cells.
D. Secretion of hemolytic toxins.
E. Production of purpuric skin lesions.

72. Which of the following statements about gonorrhea are correct?

A. Bacteremia is common.
B. Men are frequently asymptomatic carriers.
C. Penicillins are no longer recommended for treatment.
D. Diagnosis by Gram stain in men is unreliable.
E. Serologic diagnosis is more reliable than culture.

73. All of the following contribute to the virulence of the gonococcus, EXCEPT?
A. Pili.
B. Opa proteins.
C. IgA1 protease.
D. Capsule.
E. Porins

74. A 19-year-old college freshman was brought to the Emergency Room (ER) because of
severe headache,fevers, and neck stiffness. She is a resident of a dormitory. In the ER,
she was unresponsive, and had a diffuse purpuric/petechial rash; her temperature was
104∞F (40∞C). Her lumbar puncture was consistent with meningitis. A culture of her
cerebrospinal fluid was most likely to yield?
A. Eschericha coli.
B. Neisseria meningitidis.
C. Group B Streptococcus (GBS).
D. Streptococcus pneumoniae.
E. Haemophilus influenzae.
75. Refer to the case history below to answer questions 3–5. A man presents to the
emergency room with high fever and malaise. He claims to have felt this way for about 3
days, worse every day. He appears underweight and very ill. Physical examination
reveals needle marks in both antecubital fossae. Listening for heart sounds,you hear a
distinctive systolic heart murmur. You order blood cultures and make a presumptive
diagnosis of acute bacterial endocarditis. Cultures confirm your initial diagnosis and the
patient begins to respond to the drug regimen you ordered. Which one of the following
antibiotics is most likely to be effective in this case?
A. Nafcillin.
B. Methicillin.
C. Cephalosporin.
D. Penicillin.
E. Vancomycin.

76. Which of the following molecules contribute to the virulence of the organism on case
76?
A. M protein.
B. Polyglutamic acid capsule.
C. IgA1 protease.
D. Protein A.
E. Exotoxin A.

77. Which of the following are true of the treatment of toxoplasmosis?

A. Pyrimethamine and sulfadiazine are used to treat toxoplasmosis in immunocompetent
hosts.
B. Pyrimethamine and sulfadiazine are used to treat all episodes of chorioretinitis.
C. Pyrimethamine must be co-administered with folinic acid to prevent bone marrow
suppression.
D. Spiramycin is used to treat fetal infection.
E. NO Treatment of fetal infection in the first trimester.

78. Which of the following are true about the spread of trypanosomes?
A. They are inoculated directly into the bloodstream.
B. Invasion of the central nervous system occurs in the first few days.
C. A key target for T. cruzi is the reticuloendothelial system including the liver, spleen,
and bone marrow.
D. T. cruzi invades tissues and multiplies between cells rather than within cells.
E. T. brucei gambiense invades the CNS.

79. Which of the following are true of the host response to Trypanosoma brucei, except?
A. Antibody and complement lyse T. brucei species.
B. CD4+ T lymphocytes help B lymphocytes to produce anti-trypanosomal antibodies.
C. Tumour necrosis factor-a inhibits trypanosomal growth.
D. T. brucei species must inhibit apolipoprotein L-1 to avoid lysosomal killing.
E. T. brucei rhodesiense evades host antibody responses by switching between about 100
variant surface glycoproteins.

Vignette for question 80-82: In a village located at the center of Borneo, a physician who is
implementing mobile health service found a 66-year-old men who have an enlarged leg from
his groin to toe fingers. In the anamnesis the old man informed that he has an enlarged
scrotum and sometimes his urine looks like diluted milk This condition has been started since
30 years ago that developed slowly.

80. To view the presence of parasites, the specimen smear need to be stained with
A. Gram staining
B. Ziel Nielsen staining
C. Eosin staining
D. Giemsa staining
E. Iodine staining

81. The symptoms above are caused by

A. Allergy
B. Parasite toxin
C. Host immune response
D. Physical trauma
E. Proteolitic enzyme

82. The above condition is most likely caused by:

A. Brugia malayi
B. Brugia timori
C. Loa loa
D. Wuchereria bancrofti
E. Wuchereria timori

Vignette for question 83-86: A 28-year-old woman visited the health center with complaints
of abdominal enlargement experienced since one month ago. No symptom related to
urination, defecation and menstrual cycle. The woman belongs to Poso, Central Sulawesi and
just moved to Makassar 6 months ago. In the physical examination it was found slightly
enlargement of liver and shifting dullness positive. The physician suspect her to have
schistosomiasis.

83. Laboratory tests need to be done in the case above:

A. Peripheral blood smear
B. Fecal smear
C. Sputum smear
D. Urine smear
E. lymphatic fluid smear

84. Looking at the origin and the symptoms of the patient's the possible causes are
A. Schistosoma japonicum
B. Schistosoma haematobium
C. Schistosoma mansoni
D. Schistosoma mekongi
E. Schistosoma malayanum

85. The eggs of the parasite above characterized by

A. Eggs with thorns in the central
B. Egg with a hook in the lateral
C. Eggs with transversal line
D. Eggs with 6 hooks
 E. Egg with barrel shape

86. After the parasites enter the human body it will be shaped into
A. Miracidium
B. Redia
C. Sporokist
D. Cercaria
E. Schistosomula

Vignette for question 87-90: A Netherland tourist male 29-year-old came to the clinic and
complain itchy skin in his leg that been experienced since the last three days. A few days
before, he did sunbathing on Akarena beach Makassar without using any mat or towel. The
itching is very severe, especially during the night. Red winding lines skin that slightly
elevated is seen in his feet. No history of allergies and nor insect bite were reported by the
tourist.

87. The symptoms above is likely to be caused by:

A. Ankylostoma caninum
B. Ankylostoma duodenale
C. Necator americanus
D. Toxocara cati
E. Toxocara canis

88. Red winding lines skin that slightly elevated in the above cases is also called:
A. Calabar swelling
B. Creeping eruption
C. Loffler syndrome
D. Pulmonary eosinophilia
E. Ground itch

89. For local treatment can be given:

A. Salicylic powder
B. Xylol solution
C. Corticosteroid lotion
D. NaCl solution
E. Chlor Ethylene spray

Vignette for question 90-93: Trichinella spiralis is a nematode that lives the tissue. The acute
phase of infection characterized by fever, nausea, vomiting and face edema.

90. Risk factor for infection above.

A. Eating undercooked carnivore meat
B. Eating undercooked beef
C. Eating undercooked chicken meat
D. Eating undercooked crab
E. Eating undercooked green vegetables

91. The larvae of parasite are mainly found in:

A. Blood flow
B. Small intestine (duodenum)
 C. Liver
D. Colon
E. Striated muscle

92. For a definite diagnosis can be examined microscopically:

A. Blood smear
B. Duodenum fluid
C. Liver biopsy
D. Feces
E. Muscle biopsy

93. Morphological characteristic of parasites above among other:

A. Cylindrical shape
B. Flat shape
C. Ribbon shape
D. Pear like shape
E. Barrel like shape

Vignette for question 94-96: A young men attend health primary service clinic and reported
has seen a ribbon like shaped feature, size 50-90 cm in long (approximately) in his faeces.
This feature been seen as many as four times in the last 6 months. He has no other symptom
but he said that his favorite food is pork roast and pork satay.

94. The parasite in the young men faecal possibility:

A. Ascariasis
B. Drakunkuliasis
C. Enterobiasis
D. Taeniasis
E. Wuchereriasis

95. Parasites above attached to the intestinal wall by using:

A. Proglottid
B. Acetabulum
C. Tail
D. Skoleks
E. Spicules

96. Characteristic of the parasites above:

A. Cervical alae
B. Generate pupa
C. Pseudopodia
D. Mono cellular
E. Ovipar

97. A 28-year-old man makes an appointment with his physician because toes on both of his
feet are painful and they are itching him. The physician notes that the areas between his
toes are inflamed and scaling with some small vesicles present. His physician cultures
the involved areas, and after 14 days, a mold is noted in culture. The surface of the mold
is white, but the bottom of the colony is deep red when the culture is examined from the
 bottom of the plate. Abundant single microscopic examination of the mold. Which
organism is responsible for this patient’s infection?
A. Epidermophyton floccosum
B. Microsporum canis
C. Trichophyton mentagrophytes
D. Trichophyton rubrum
E. Trichophyton tonsurans

98. A 51-year-old bone marrow transplant patient became febrile 1 week after
transplantation. The skin overlying an intravenous catheter is inflamed. Blood cultures
are collected, and antibiotic therapy with ceftazidime and vancomycin is initiated. The
catheter is removed and also cultured. After 2 days of incubation, the laboratory reports
two blood cultures and the catheter as a positive with yeast. Preliminary tests are
performed and yield the following results: germ tube, positive; urease, negative; phenyl
oxidase, negative; glucose utilization, positive. Which organism is responsible for this
patient’s infection?
A. Candida albicans
B. Candida glabrata
C. Candida parasilopsis
D. Candida tropicalis
E. Cryprococcus neoformans

99. A 25-year-male presented with fever, dry, cough and dyspnea. A sputum sample was
induced but it failed to reveal organisms on Gram stain. The sputum also failed to grow
organisms when cultured on a variety of agars; however, bacteria were isolated in
cultured eukaryotic cells. What is the cause of this man’s disease?
A. Chlamydophila pneumoniae
B. Legionella pneumoniae
C. Mycobacterium intracellular
D. Mycobacterium tuberculosis
E. Mycoplasma pneumoniae

100.A 67-year-old male presents with fever and an erythematous, swollen, tender, warm calf.
He is diagnosed clinically with cellulitis and catalase-negative, β-hemolytic Gram
positive cocci are isolated from blood cultures. Which virulence factor of the causative
organism enabled it to cause this invasive disease?
A. An A-B exotoxin
B. Lipopolysaccaharide
C. P Fimbriae
D. Streptokinase
E. Proteins