LS4 clinical microbiology

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Microbiology lecture 3 Micro lab exam 1 [MIC

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A 22-year-old man who B
recently immigrated to the
United States comes to the
physician with jaundice,
fever, abdominal pain. He
takes no medication and has
no known allergies.
Laboratory testing Yields the
following results: Anti-
hepatitis A IgM Positive Anti-
HBs Positive Anti-HBc
Positive HBsAg negative
Which of the following do
these laboratory findings
most likely suggests?
A. Acute Hep B infection
B. Acute Hep A infection
C. Chronic Hep B infection
D. None of the above
22-year old woman develops D
symptoms with hepatitis.
Serologic tests for HBsAg,
antibodies to HBsAg, and
hepatitis A virus (HAV) are all
negative; however, she is
positive for IgM core
antibody. The woman
(Clinical)
A. She does not have
hepatitis B
B. She has hepatitis A
C. She is in the late stages of
hepatitis B infection
D. She is in the "window"
(after the disappearance of
HBsAg and before the
appearance of anti-HBsAg)
E. She has hepatitis C
A 39 year-old patient has E
chronic inactive Hepatitis B
with low infectivity. Choose
the most appropriate
combination of serologic
markers: (Clinical)
A. HBsAg - HBeAg - Anti
HBsAb+ Anti- HBcAg+ Anti-
HBeAg
B. HBsAg + HBeAg - Anti
HBsAb + Anti- HBcAg -Anti-
HBeAg
C. HBsAg - HBeAg - Anti
HBsAb- Anti- HBcAg+ Anti-
HBeAg +
D. HBsAg + HBeAg - Anti
HBsAb - Anti- HBcAg+ Anti-
HBeAg +
E. HBsAg + HBeAg + Anti
HBsAb- Anti- HBcAg+ Anti-
HBeAg-
Which of the following C
clinical scenario most likely
explains the following
serologic markers found in
the 17 year-old boy: Anti-
HAV IgM + Anti-HAV IgG-
HBsAg + HBeAg - Anti
HBsAb- Anti- HBcAg+ Anti-
HBeAg + Anti-HCV- (Clinical)
A. Acute Hepatitis A plus
chronic HCV
B. Acute Hepatitis C
C. Acute Hepatitis A plus
Hepatitis B
D. Acute Hepatitis B plus
acute HDV E. Acute Hepatitis
E

5. Which of the following E

clinical scenario most likely
explains the following
serologic markers found in
the 17 year-old boy: Anti-
HAV IgM + Anti-HAV IgG-
HBsAg + HBeAg - Anti
HBsAb- HBcAg+ Anti-HBeAg
+ Anti- HCV-
A. Acute Hepatitis E
B. Acute Hepatitis A plus
chronic HCV C. Acute
Hepatitis B plus acute HDV
D. Acute Hepatitis C
E. Acute Hepatitis A plus
Hepatitis B
6. Vaccination with Hep B C
recombinant vaccine leads
to production of which
type/types of antibodies?
A. Anti-HBc
B. Anti-HBe
C. Anti-HBs
D. All of the above

Which of the following is the A

correct interpretation of HBV
serologic markers' dynamics
shown in the graph below?
(C. Micro)
A. The patient had Acute
Hepatitis B that progressed
to chronic Hepatitis with high
infectivity
B. The patient has an
exacerbation of chronic
Hepatitis B
C. The patient successfully
recovered
D. The patient was
vaccinated against HBV
previously
E. The patient had Acute
Hepatitis B that progressed
to chronic Hepatitis with low
infectivity
A 34 year old nurse with C
recent onset of malaise is
found to have the following
set of laboratory findings:
Anti HAV IgM - positive, Anti
HAV IgG - negative, HBsAg
— negative, HBeAg —
negative, Anti-HBsAg —
positive, Anti-HBcAg -
negative, Anti- HBeAg -
negative, Anti- HCV —
negative. The patient most
likely: (C. Micro)
A. Had an accidental
needlestick
B. Had a recent tattoo
C. Had raw oysters at local
restaurant D. Had
unprotected sexual
intercourse

All of the following is A

associated with chronic
Hepatitis C infection. Except:
(C. Micro)
A. Severe fatal illness during
pregnancy B. Essential mixed
cryoglobulinemia
C. Hepatocellular carcinoma
D. Fulminant Hepatitis
E. Palpebral Purpura
Which of the following set of D
test result corresponds to
the patient with chronic HBV
infection and is
superinfected with HDV? (C.
Micro)
A. HBsAg - , HBeAg - ,
ANTI-HBcAg IgM -, ANTI-
HBcAg IgG -, ANTI-HBs Ag
+, ANTI-HDV IgM+
B. HBsAg + HBeAg +, ANTI-
HBc IgM+, ANTI-HBc IgG-,
ANTI-HBs Ag-, ANTI-HDV
IgM+
C. HBsAg - HBeAg -, ANTI-
HBc IgM-, ANTI-HBc IgG+,
ANTI-HBs Ag+, ANTI-HDV
IgM+
D. HBsAg + HBeAg +, ANTI-
HBc IgM-, ANTI-HBc IgG+,
ANTI-HBs Ag-, ANTI-HDV
IgM+

A previously healthy patient D

develops condition that has
all the characteristics
resembling hepatitis A virus
(HAV), yet all diagnostic
tests for HAV are
nonreactive. A most likely
cause of this infection is: (C.
Micro)
A. Hepatitis B
B. Hepatitis C
C. Hepatitis D
D. Hepatitis E
E. Rotavirus
A 32-year-old tattoo artist D
has the following readings of
serologic markers for viral
hepatitis: Anti-HAV IgM -
negative, Anti-HAV IgG
positive, HBsAg - negative,
HBeAg - negative, Anti-
HBsAg - positive, Anti-
HBcAg IgM - negative, Anti-
HBcAg IgG - positive, Anti-
HCV negative. The patient
most likely:
A. Is actively shedding HAV
B. Is infected with HDV
C. Is an asymptomatic carrier
of HBV D. Has recovered
from HBV
E. Has been vaccinated
against HBV
A 33-year-old nurse suffered C
a needle stick injury. Her
patient used illicit
intravenous drugs. One
month later, the nurse
develops jaundice. Which of
the following findings would
implicate hepatitis B as the
etiology?
A. Positive antihepatitis B
surface antibody B. Positive
antihepatitis -core antibody
C. Positive hepatitis B
surface antigen
D. Positive antihepatitis B
envelope antibody E.
Positive antihepatitis A
antibody

42-year-old HIV patient with E

CD4 T cell count of 32
complains of increasing
dyspnea. This patient is
diagnosed with MAC
infection. Prophylactic
administration of which of
the following could have
prevented this infection?
(Clinical)
A. High dose penicillin B.
Isoniazid
C. Streptomycin
D. TMP-SMX
E. Azithromycin
A 43-year-old man HIV E
infected male is non-
compliant with his treatment
and is found to have a CD4
count of 80/microL. In
addition to his antiretroviral
regimen, what medication
should be initiated? (Clinical)
A. Fluconazole
B. Azithromycin
C. Acyclovir
D. Isoniazid
E. Trimethoprim-
Sulfamethoxazole

A 46-year-old man comes to C

the emergency department
with fever,
lymphadenopathy, sore
throat, fatigue, rash, night
sweats . He has a history of
intravenous drug use. If
untreated increased risk of
development of
opportunistic infections and
cancers, such as
Pneumocystis carinii
infection and Kaposi
sarcoma. Which of the
following is the most likely
cause of condition?
A. Cytomegalovirus
B. Cryptococcus neoformans
C. HIV
D. Toxoplasma gondii
E. Varicella zoster virus
A 23-year-old man develops D
fever and weight loss for the
past 3 weeks. He is a soldier
in the U.S. Army who
recently returned from a tour
of duty in the Middle East.
Physical exam was
noncontributory. Laboratory
tests revealed anemia and
leukopenia. Multiple blood
cultures for bacteria and
fungi were negative, as was a
test for the p24 antigen of
HIV. CT scan of the
abdomen revealed
splenomegaly. A bone
marrow biopsy was
performed, and a stained
sample revealed
amastigotes within
mononuclear cells. The
patient most likely has?
A. African sleeping sickness
B. Toxoplasmosis
C. Malaria
D. Visceral leishmaniasis
E. Chage's disease
Your patient is a 25-year-old A
man with fever and weight
loss for the past 3 weeks. He
is a soldier in the U.S. Army
who recently returned from
a tour of duty in the Middle
East. Physical exam was
noncontributory. Laboratory
tests revealed anemia and
leukopenia. Multiple blood
cultures for bacteria and
fungi were negative, as was a
test for the p24 antigen of
HIV. CT scan of the
abdomen revealed
splenomegaly. A bone
marrow biopsy was
performed, and a stained
sample revealed
amastigotes within
mononuclear cells. Of the
following, which one is the
most likely cause?
A. L. donovani
B. P. falciparum
C. T. gondii
D. T. brucei
E. T. cruzi
Which of the following E
modes of transmission of
human immunodeficiency
virus (HIV) occurs
significantly MORE often
than the others?
A. Direct skin contact
B. During childbirth
C. Fecal-oral route
D. Respiratory aerosols
E. Blood transfusion

37-year-old otherwise D
healthy man with no
complaints wants to donate
blood and he tests positive
for HIV ELISA. What is the
next best step ? (C. Micro)
A. Measure HIV viral RNA
B. Continue with Western
blot
C. Measure CD4T cells
D. Repeat ELISA
The 41-year-old male is B
determined to have
increased HIV ELISA titer
followed by positive
Western blot analysis. Which
of the following is the
correct interpretation of
these findings?
A. The patient has been
exposed to HIV
B. The patient is infected with
HIV
C. The patient is not infected
with HIV
D. It is not possible to
diagnose infection
according to these results
E. PCR of the HIV RNA is
also required to confirm the
HIV status in this patient

42-year-old male with D

uncontrolled AIDS
complains of progressive
blurring of vision in his right
eye. Eye examination reveals
evidence of retinitis with
cytomegalic viral inclusion
disease. Risk of this disease is
highest, when CD4 T cell
count drops below:
A. CD4 <100/ microliter
B. CD4 <300/ microliter
C. CD4 <400/ microliter
D. CD4 <50/ microliter
E. CD4 <200/ microliter
45-year-old man with AIDS B
comes to emergency
department with fever and
decreased vision. He is
eventually diagnosed with
viral retinitis. The same virus
causes which of the
following conditions in a
healthy host?
A. Hepatisis
B. Mononucleosis
C. Esophagitis
D. Brain abscess E. Shingles
F. Lymphoma

A 39-year-old man was C

diagnosed with
Pneumocystis pneumonia
(PCP. His wife gives a 6-
month history of her
husband gradually losing
weight and becoming
generally unwell. The patient
of IV drugs use about 5
years ago. Low lymphocyte
count was found on his
routine blood tests. What is
the best next step to find the
etiology of his symptoms?
A. Wesern blotting
B. Serology
C. ELISA
D. Bronchoalveolar lavage
(BAL) E. PCR
Viruses which carry an RNA- C
dependent RNA polymerase
within the virion include all
the following EXCEPT:
A. Influenza virus.
B. Rabies virus.
C. HIV.
D. Reovirus.
E. Measles virus.

A 43-year-old woman with D

HIV is admitted with new-
onset seizures. The CT scan
of the head reveals multiple
ring-enhancing lesions of the
brain. which of the following
is the most appropriate
combination of the causing
organism and CD4 T cell
counts?
A. Trypanosoma Cruzii: CD4
T cells <200
B. MAC: CD4 T cells <50
C. Cryptococcus
Neoformans: CD4 T cells
<100
D. Toxoplasma Gondii: CD4 T
cells <100
E. Pneumocystis Jirovecii:
CD4 T cells <200
F. Hispoplasma Capsulatum -
CD4 T cells <100
A 50-year-old man originally B
from the Carribean islands
complains of weakness and
chronic constipation. He has
an erythematous rash
covering > 90% of his body
surface area, with well-
demarcated papules as well
as purpuric lesions. He is
also found with
hepatosplenomegaly and
lymphadenopathy. A
peripheral blood smear
reveals "flower" cells. Which
virus most likely have caused
the desease?
A. Poxvirus
B. Papillomavirus
C. Retrovirus
D. Herpesvirus

Laryngeal papillomas in D
children can be caused by
which of the following
viruses:
A. Caliciviridae
B. Moiluscum contagiosum
virus
C. Polyomavirus JC
D. Papillomaviruses
A sexually active woman was D
seen for a routine
gynecologic exam that
included a Pap smear. The
report indicated cervical
intraepithelial neoplasia.
Human papilloma virus
(HPV) type 16 genome is
found within the neoplastic
cells. Which of the following
process is required for HPV
to lead to the development
of cancer? (Immune)
A. Mutation of the virus
B. Loss of HPV E6 and E7
genes
C. Viral replication
D. Inactivation of p53 and RB
proteins
A 42-year-old woman with a D
previous history of abnormal
Pap smears and positive HPV
DNA testing is lost to follow-
up, but presents with vaginal
bleeding 10 years later.
Physical examination finds a
3-cm lesion of the cervix.
Histologic examination of
this lesion is most likely to
reveal which of the following
abnormalities? (C. Micro)
A. Clear cell carcinoma
B. Verrucous carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
(Cervical cancer)
E. Adenocarcinoma

Which of the following B

viruses and the potential
complications are
mismatched?
A. EBV - Development of
nasopharyngeal carcinoma
B. HPV - Development of
ovarian cancer
C. Measles virus - Transient
immunosuppression D.
Mumps - Aseptic meningitis
E. Rubella - purpuric rash in
a newborn
Your patient is a 30-year-old B (scarlet fever -> strawberry tongue )
woman with nonbloody
diarrhea for the past 14
hours. Which one of the
following organisms is LEAST
likely to cause this illness?
(Clinical)
A. Clostridium difficile
B. Streptococcus pyogenes
C. Shigella dysenteriae
D. Salmonella enteritidis

Your new patient is young D

female from Ireland, who
came to visit Georgia 4 days
ago. She complains of
diarrhea, crampy abdominal
pain and is nauseated. Stool
analysis doesn't show RBCs
or increased WBCs. Which of
the following pathogenic
bacteria is MOST
COMMONLY associated with
this condition?
A. Shigella sonnei
B. Salmonella typhimurium
C. Yersinia enterocolitica
D. Escherichia coli ETEC
(enterotoxingenic).
E. Campylobacter jejuni
Which of the following D
pathogenic bacteria is
MOST. COMMONLY
associated with traveler's
diarrhea?
A. Shigella sonnei
B. Salmonella typhimurium
C. Yersinia enterocolitica
D. Escherichia coli ETEC
(enterotoxingenic).
E. Campylobacter jejuni

You isolate a virus from the B

stool of a 1-year-old infant
with signs of fever, vomiting,
and diarrhea. Laboratory
results show that the viral
genome is composed of
multiple segments of
double-stranded RNA.
Which of the following is the
most likelycausing agent of
this patient's condition?
A. Rhinovirus
B. Rotavirus
C. RSV
D. Rubella virus
E. Norovirus
F. Adenovirus

Giardia lamblia usually C

causes: (Clinical)
A. Encephalitis
B. Hepatitis
C. Gastroneteritis
D. Pneumonia
A 15-year-old boy returns A (found in surface of food,water,soil)
from a backpack trip with
foul-smelling watery
diarrhea. On further
questioning, he admits to
drinking water from a
mountain brook without first
boiling it. Stool is sent for
microscopic examination,
confirming the diagnosis of
infection. Which of the
following is the most likely
cause?
A. Giardia lamblia
B. Rotavirus
C. Norovirus
D. Candida albicans
E. Ascaris lumbricoides
F. CMV

Cryptosporidium parvum D
causes:
A. Urinary tract infections in
children;
B. Eye infections in elderly;
C. Meningoencephalitis in
pregnant women;
D. Severe diarrhea in
immunocompromised.
Several Papua New Guinea E
villagers known to eat pork
during celebrations were
reported to be suffering
from an outbreak of
epileptiform seizures. One of
the first things you should
investigate is (Clinical)
A. The prevalence of Ascaris
infections in the population
B. The presence of
Toxoplasma gondii in cats
C. The presence of
Trypanosoma brucei
gambiense in the villagers
D. The presence of Taenia
eggs in the drinking water
E. The presence of adult
Taenia solium in the pigs

A patient whose major E

source of protein is smoked
fish, develops vitamin B12
deficiency anemia. Which of
the following is the most
likely associated with the
above-mentioned condition?
(C. Micro)
A. Hepatitis A virus
B. Hymenolepis nana
C. Echinococcus granulosus
D. Schistosoma japonicum
E. Diphyllobothrium latum
F. Taenia solium
A 4-year-old girl is brought A
to the office by her mother
because of anal itching. The
mother has noticed her
daughter scratching and
rubbing her anal area
frequently for the past few
days. She attends daycare 4
days a week. On
examination, she is a well-
appearing child. Her vital
signs and general
examination are normal. You
perform a microscopic
examination of a sample
collected by touching the
perianal region with a piece
of clear cellophane tape.
What is the most likely cause
of her symptoms?
A. Enterobius vermicularis
B. Ascaris lumbricoides
C. Schistosomiasis
D. Diphyllobothrium latum
E. Taenia solium

In Tania tapeworm infections B

the mature adult worms are
usually found in
A. Lungs
B. GI tract
C. Liver
D. CNS
Gram-positive cocci isolated E
from the patient is able to
metabolize sucrose to lactic
acid. The bacteria most likely
contribute to which of the
following pathological
states?
A. Abscess formation
B. Paroxysms of cough
C. Skin rash
D. Pharyngitis
E. Dental Carries

An 8-year-old boy is A
brought in to the office with
a 3- day history of fever and
mild sore throat. The rash
started on his face and
spread to his arms and legs.
On examination, his
temperature is 37.7°C, and
his other vital signs are
normal. His cheeks are
notably red, pharynx is
normal-appearing. On his
extremities there is a fine,
erythematous,
maculopapular rash but no
vesicles or petechia. What is
the most likely diagnosis?
(Clinical)
A. Erythema Infectiosum
B. Erythema marginatum
C. Erythema multiforme
D. Erythema infantum
E. Erythema nodosum
A person with asthma has an C
acute exacerbation with
increased lower respiratory
illness. A virus is recovered.
The isolate is most likely to
be which of the following
virus types?
A. Parainfluenza virus (upper)
B. Parechovirus
C. Rhinovirus
D. Respiratory syncytial virus
(upper and lower)
E. Echovirus

A 15-year-old girl presents B

with fever, sore throat,
odynophagia and a number
of grayish-white papulo-
vesicular lesions on the soft
palate, uvula, and tonsils.
Which of the following is the
most likely diagnosis of this
patient?
A. EBV
B. Herpangina (coxascakie A
)
C. Strep throat
D. CMV esophagitis
E. Primary herpes
F. Hand foot and moth
disease
Plasmodium parasites cause D
malaria. In the first stage of
infection the parasites infect
A. Nerve cells
B. Hepatocytes
C. Intestinal epithelium
D. Erythrocytes

A 6-year-old unvaccinated D
child develops
lymphadenopathy behind his
ears followed by
appearance of reddish rash
that started on his forehead
and spread to his trunk.
Minimal fever is present but
the child generally feels well.
What is the most likely cause
of his symptoms?
A. Epstein-Barr
B. Varicella zoster
C. Mumps
D. Rubella (German measles)
E. Measles (Rubeola)

Which drug has been A

approved by the Food and
Drug Administration (FDA) to
treat Covid
A. Remdesivir
B. Ribavirin
C. Alpha interferon
D. Entecavir
A 32-year old sexually F
experienced female
complains of increased
vaginal discharge and
vaginal pruritus. Increased
PMN cells are found in her
vaginal swab. Which of the
following is the most likely
cause of her symptoms?
(Clinical)
A. M. pneumoniae
B. Acute HIV syndrome
C. Syphilis
D. Herpes simplex virus
E. Papillomavirus
F. C. Trachomatis

Toxin of which of the B

following bacteria causes
ADP- ribosylation of
elongation factor 2 and
inhibits protein synthesis?
(Clinical)
A. Clostridium tetani
B. Corynebacterium
Diphtheriae
C. E.Coli
D. Streptococcus pyogenes
A 54-year old female is D
hospitalized for severe
headache and confusion.
CSF is obtained by lumbar
puncture and it shows
Increased protein
concentration, increased
lymphocytes and low
glucose concentration. IGRA
test is positive. What is the
most likely cause of this
patient's condition? (Clinical)
A. L. Monocytogens
B. S. pneumoniae
C. N. Meningitis
D. M. Tuberculosis
E. H. Influenzae Type B
An 18 month old boy is A
brought to the physician by
his parents for fever, runny
rose, and sore throat. The
physician reassures the
parents and recommends
supportive care with plenty
of fluids. He sends them with
instructions to follow up if
the boy's symptoms worsen.
Two days later, the infant is
brought to the emergency
department with persistent
fever, brassy cough, and
difficulty breathing. Physical
examination reveals stridor.
Which of the following
pathogens is most likely
responsible for the patient's
condition? (Clinical)
A. Paramyxovirus
B. Parvovirus
C. Calicivirus
D. HSV1
E. Respiratory syncytial virus
A 59-year-old woman C
underwent hip joint
replacement surgery. Metal
prosthesis had to be placed.
1 month later she developed
fever of 38.60C and the
surgical wound started to
drain pus. According to her
risk- factors, which of the
following is the most likely
cause of her symptoms?
(Clinical)
A. Streptococcus bovis
B. Viridans group
Streptococci
C. Staphylococcus
Epidermidis
D. Streptococcus pyogenes
E. Staphylococcus
saprophyticus
A 25-year-old female C
medical student reports that
she had lunch at Fish
restaurant in the afternoon.
She reports eating sushi and
seafood. She is presented in
the emergency department
of hospital with the
complaints of abdominal
cramps, nausea and
vomiting. Culture and gram
stain reveal no pathologic
bacteria. Which of the
following is the most likely
cause of this infection?
(Clinical)
A. Clostridium botulinum
food poisoning
B. Listeria monocytogens
C. Norovirus
D. E. coli EIEC
E. Rotavirus
F. Clostridium difficile

Several pathogens are C

transmitted either during
gestation or at birth. Which
one of the following is LEAST
likely to be transmitted at
these times? (!!!) (Clinical)
A. CMV
B. T. Pallidum
C. Parvovirus B19
D. Hepatitis B
E. Hepatitis C
F. Rubella virus
A 52-year-old woman B
develops ring-like rash. Over
the next 5 months, she has
migratory arthralgias and
myalgias. Which of the
following cardiologic
complication is characteristic
in this condition? (Lyme
disease)
A. Dilated cardiomyopathy
B. Heart block
C. Tricuspid regurgitation
D. Ascending aortic
aneurysm
E. Mitral valve stenosis

An 11-year-old boy develops C

sore throat, headache,
tearing and bilateral
conjunctivitis. After medical
exam, he is found to have
fever of 37.80C and mild
preauricular
lymphadenopathy. Within
the next 2 days, several of his
classmates develop similar
symptoms. which of the
following is most likely
cause? (Clinical)
A. HSV-1
B. Parvovirus B19
C. Adenovirus
D. Chlamydia
E. S. aureus
F. Mumps virus
A 9-year old boy is admitted C
to ER with complaints of
severe pain of left leg: He is
unable and refuses to walk.
He has fever of 38.7oC.
WBCs are elevated. which of
the following is the most
likely cause of his
symptoms?
A. N. meningitis
B. B. burgdorferi
C. S. aureus
D. Coxsackievirus B
E. M. tuberculosis
A 7 year old girl presents E (enlarged lymph node, no cough,white
with a 3-day history of sore exudates)
throat. She has pain with
swallowing and even with
talking. She also has felt
feverish for the past 2 days.
She has no cough, runny
nose, or shortness of breath.
On oropharyngeal exam, her
pharynx is erythematous and
swollen. Tonsils are also
edematous, red, and
covered with whitish
exudate. The cervical lymph
nodes are swollen and
tender. What is the most
likely cause of her
symptoms?
A. Haemophilus influenza
type B
B. Bordetella pertussis
C. Coxsackievirus
D. Adenovirus
E. Streptococcus pyogenes
F. Mycoplasma pneumonia
A 32-year old sexually F
experienced female
complains of increased
vaginal discharge and
vaginal pruritus. Increased
PMN cells are found in her
vaginal swab. Which of the
following is the most likely
cause of her symptoms?
A. M. pneumoniae
B. Herps simplex virus
C. Syphilis
D. Acute HIV syndrome
E. Papillomavirus
F. C. Trachomatis

39 year old otherwise D

healthy patient devlops chills
and high fever of 39.2oC.
Next day he complains of
cough productive of yellow
sputum. He is diagnosed
with Community acquired
pneumonia. Which of the
following is the most likely
causing agent?
A. H. Influenza
B. M. Pneumoniae
C. L. Pneumoniae
D. S. Pneumoniae
E. C. Pneumophilia
A 43-year-old man, a recent B
immigrant from Botswana, is
brought to the emergency
room with a cough
productive of bloody
sputum. He first noticed a
cough approximately 2
months ago. He reports
having lost approximately
5kg in this time frame as well.
He also notes that he's had
drenching night sweats 2 or
3 nights a week for the past
month. Which of the
following is the most likely
cause of his condition?
A. S. Pneumoniae
B. M. Tuberculosis
C. HIV
D. Chronic HVC

A 10-year-old child develops E

fever and headache. Acute
viral meningitis is diagnosed.
What is the most likely cause
of this child's infection?
A. HSV-1
B. Rubella
C. EBV
D. Mumps virus
E. Enterovirus
F. N. Meningitides
A 70-year-old woman has D
fever, chills, and myalgias. It
is January and an outbreak of
influenza is occurring in the
retirement community in
which she lives. A rapid test
for influenza antigen is
positive. Which one of the
following is the best choice
of drug to treat the
infection?
A. Acyclovir
B. Amantadine
C. Interferon
D. Oseltamivir
A 35-year-old spelunker C (rabies is a - single stranded RNA virus )
presents to the emergency
room complaining of one
week of worsening malaise.
His last solo spelunking trip
was two months ago. While
in the examination room, he
asks to turn down the lights
because they are too bright.
His temperature is 101°F
(38.3°C), blood pressure is
130/80 mmHg, pulse is
100/min, and respirations are
18/min. On examination he
appears tremulous and
agitated. He is oriented to
person and place but not
time. Which of the following
pathogens is most likely
responsible for this patient's
condition?
A. Echovirus
B. HSV 1
C. Rabies virus
D. Polio virus

Exposure to rubella early in D

pregnancy can result an
infant to develop:
A. Disseminated vesicular
rash
B. Intracerebral calcifications
C. Ventricular septal defect
(VSD)
D. Cataracts
E. Hearing loss
F. Thrombocytosis
A 25-year-old female F
medical student reports that
she had lunch at Fish
restaurant in the afternoon.
She reports eating sushi and
seafood. She is presented in
the emergency department
of hospital with the
complaints of abdominal
cramps, nausea and
vomiting. Culture and gram
stain reveal no pathologic
bacteria. Which of the
following is the most likely
cause of this infection?
A. Clostridium difficile
B. E. coli EIEC
C. Rotavirus
D. Clostridium botulinum
food poising
E. Listeria monocytogens
F. Norovirus

Which of the following B

viruses causes infectious
mononucleosis and
becomes latent in B-cells?
A. Varicella-zoster virus
B. Epstein-Barr virus
C. Cytomegalovirus
D. Human herpesvirus 6
E. Herpes simplex, virus type
2
A 30-year-old asymptomatic B (tests for syphilis )
woman is found to have a
positive VDRL test. She
denies having had sexual
contact with a partner who
had symptoms of a venereal
disease. The next best step
would be to:
A. Reassure her that the test
is a false-positive if she
doesn't have any symptoms
B. Perform FTA-ABS test on a
specimen of her serum
C. Treat her with penicillin
D. Trace her sexual contacts
for serologic testing

Toxin of which of the A

following bacteria binds to
the motor end plate at
neuromuscular junctions and
causes irreversible muscle
contractions
A. Clostridium tetani
B. Corynebacterium
Diphtheriae
C. E Coli
D. Streptococcus pyogenes

A 10-month-old infant A
developed a croup. The
most likely cause of the
disease is
A. Parainfluenza vinic
B. Rhinovirus
C. Influenza virus
D. Measles virus
A 15-year-old girl presents B
with fever, sore throat,
odynophagia and a number
of grayish-white papulo-
vesicular lesions on the soft
palate, uvula, and tonsils.
Which of the following is the
most likely diagnsis of this
patient?
A. Strep throat
B. Herpangina
C. Primary herpes
D. CMV esophagitis
E. EBV

A 33-year-old man is B
admitted to the hospital due
to new onset seizures. He
has no significant medical
history. Vital signs are
normal. Neurologic
examination shows no
abnormalities. CT scan of the
head reveals a 3cm cystic
lesion in the temporal lobe.
The mass is excised and
histopathology is shown in
the image below. Which of
the following is the most
likely diagnosis? (!!!)
A. Meningioma
B. Tuberculosis
C. Infection with the
tapeworm
D. Metastatic disease
A 4-year-old girl is brought B
to the physician's office by
her mother because of anal
itching. The mother has
noticed her daughter
scratching and rubbing her
anal area frequently for the
past few days. The child
attends day care.
Examination of her perianal
area reveals some erythema
and excoriation from
scratching. You perform a
microscopic examination of
a sample collected by
touching the perianal region
with a piece of clear
cellophane tape. What is the
most likely diagnosis of this
girl? (C. Micro)
A. Ascaris lumbricoides
B. Enterobius vermicularis
C. Dracunculus medinensis
D. Onchocerca volvulus
E. Wuchereria bancrofti
Which of the following A
would be present in neonate
with congenital rubella
Syndrome but not in a
neonate with
cytomegalovirus inclusion
disease? (C. Micro)
A. Hearing loss
B. Pulmonary artery stenosis
C. Mental retardation
D. Hepatosplenomegaly
E. Intrauterine growth
retardation

An infant with microcephaly, D

jaundice and
hepatosplenomegaly was
small for gestational age and
had thrombocytopenia.
Cataracts are noted.
Ultrasound of patient's heart
revealed patent ductus
arteriosus. Which one of the
following viruses most likely
caused these congenital
malformations? (C. Micro)
A. CMV
B. Mumps virus
C. RSV
D. Rubella virus
E. HIV
39-year-old male presents to A
your office in January with
the sudden onset of high
fever (39.3oC), headache,
myalgias and severe sore
throat. What is the first-line
medication's mechanism of
action? (C. Micro)
A. Inhibition of
neuraminidase
B. Inhibition of reverse
transcriptase
C. Inhibition of protease
D. Inhibits Hemagglutinin
E. Inhibition of monoamine
oxidase (MAO)

A 14-year-old boy presents A (EBV)

with fever, sore throat, and
cervical lymphadenopathy.
Then he develops
splenomegaly lasting for 2
months. His peripheral blood
smear shows leukocytosis
with "atypical" lymphocytes.
Heterophil antibody test is
positive. Which of the
following can be caused by
the same infectious agent?
A. Burkitt Lymphoma
B. Zoster
C. Retinitis
D. Kaposi sarcoma
E. Deafness
67-year-old man comes to D (shingles )
your office due to a rash that
appeared on his chest
yesterday. On exam a
unilateral vesicular rash
involving a single
dermatome is present on his
left chest. Which of the
following is this patient most
likely to suffer from within
the next 3 months? (C.
Micro)
A. Normochromic anemia
B. Recurrent skin rashes of
similar pattern
C. Visual impairment
D. Persistent local pain
E. Facial paralysis

10 days after having A

unprotected sexual contact
with the new partner a 23-
year-old woman develops
low- grade fever and
multiple, very painful,
vesicular lesions on the
vulva. Which of the following
is the possible complication
of this condition(C. Micro)
A. Meningitis
B. Pancreatitis
C. Myocarditis
D. Cervical cancer
E. Splenic rupture
F. Chicken pox
 Pic (C. Micro) A
A. Coxsackievirus
B. Parvovirus
C. Adenovirus
D. Herpesvirus 6
E. Paramyxovirus
F. Togavirus

A 4-year-old girl presents to D

her pediatrician's office with
fever and a pruritic rash on
her torso and upper arms.
Macules, vesicles, crusts are
visualized on the physical
exam. What is the most likely
diagnosis? (C. Micro) (NEW)
A. Rubella
B. Roseola infantum
C. Erythema infectiosum
D. Chickenpox
E. Measles
F. Hand-foot-and-mouth
Disease
Previously healthy and D
physically active 23-year-old
male comes to your office
with the complaints of
severe dyspnea. He is a
former basketball player and
used to exercise regularly
until 10 days ago, when he
developed flu-like febrile
illness. Starting from that,
patient gradually developed
increasing fatigue and
shortness of breath. He also
reports occasional
paroxysms of "heart racing".
Serum levels of Troponin-|
and CPK are elevated.
Echocardiography shows
decreased ejection fraction.
Which of the following is the
most likely viral cause of his
symptoms? (C. Micro)
A. Enterovirus 71
B. Calicivirus
C. Echovirus 31
D. Parainfluenza virus
E. Coxackievirus A
F. Coxsackievirus B
A 6-year-old girl has a fever A
and nonspecific viral
symptoms for 3 days. Rash
appeared on her face today.
The rash is bright red and
located over the both
cheeks. The rash is macular;
there are no papules,
vesicles, or pustules. She
recovers from this illness
without any complications.
What is the most likely
diagnosis? (C. Micro)
A. Erythema infectiosum
B. Roseola infantum
C. Measles
D. Hand-foot-and-mouth
Disease
E. Chickenpox
F. Rubella

An otherwise healthy 11- A

year-old child presents with
low-grade fever, sore throat
and red, irritated eyes. On
examination, the patient is
noted to have pharyngitis
and bilateral conjunctivitis.
Which of the following is the
most likely etiologic agent?
A. Rhinovirus
B. Adenovirus
C. Metapneumovirus
D. Coronavirus
E. Influenza virus
6-year-old unvaccinated boy E (face and body rash (rubella))
is brought to your office with
the complaints of a low-
grade fever, arthralgia and a
skin rash. The rash started on
his face and spread rapidly
down his body. Physical
exam shows a generalized
maculopapular rash and
bilateral cervical
lymphadenopathy. Which of
the following is the likely
cause of this patient's illness?
(C. Micro)
A. Parainfluenza virus
B. Parvovirus
C. Paramyxovirus
D. Coxsackievirus
E. Togavirus
F. Herpesvirus 6
4 year-old unvaccinated A (measles = coryza)
child presents with a 3-day
history of malaise, fever of
38.9°C, cough, coryza, and
conjunctivitis. He then
develops the erythematous,
maculopapular rash. He is
noted to have white pinpoint
lesions on a buccal mucosa.
The most likely diagnosis is:
(C. Micro)
A. Measles
B. Rubella
C. Chickenpox
D. Erythema infectiosum
E. Hand-foot-and-mouth
Disease
F. Roseola infantum

An otherwise healthy 16 D
year-old boy develops
increasing blurring of vision
over the last 2 days.
Necrotizing retinal infiltrates
are seen by funduscopic
exam. Which of the following
is the most likely cause?
A. Toxoplasma gondii
B. Balamuthia mandrilaris
C. Measles virus
D. CMV
E. Acanthamoeba species
F. Giardia lamblia
Parvovirus infection, the A
cause of a mild exanthem in
childrcharacterized by (C.
Micro)
A. Acute hemolytic anemia
B. Epidemic acute respiratory
disease
C. Gastroenteritis
D. Whooping cough-like
disease
E. Keratoconjunctivitis

A 6-month-old child D
develops a persistent cough
and a fever. Physical
examination and chest X-ray
suggest pneumonia. Which
one of the following
organisms is LEAST likely to
cause this infection?
A. Respiratory syncytial virus
B. Adenovirus
C. Parainfluenza virus
D. Rotavirus
A 10-month-old child has a B (hhv6 and hhv7 dont really do much)
temperature of 40°C for 4
days without other signs. On
the fourth day a rose pink,
maculopapular rash appears
and the temperature returns
to normal. What is the most
likely diagnosis?
A. Echovirus
B. human herpes virus 6
C. measles virus
D. Parvovirus
E. Rubella

Which of the following is the B

antiparasitic drug:
A. Fuzeon;
B. Albendazole;
C. Ribavirin;
D. Ciprofloxacin.

Perianal pruritus is the most D

prominent symptom of:
A. Taeniasis;
B. Echinococcosis
C. Trichinelosis
D. Enterobiasis.
A 6-year-old unvaccinated C (forehead to trunk)
child develops
lymphadenopathy behind his
ears followed by
appearance of reddish rash
that started on his forehead
and spread to his trunk.
Minimal fever is present but
the child generally feels well.
What is the most likely cause
of his symptoms?
A. Epstein-Barr
B. Mumps
C. Rubella
D. Measles (Rubeola)
E. Varicella zoster

A 23-year-old female stores C

her contact lenses in the
container filled with tap
water. She noticed
deterioration of vision and
visited an ophthalmologist
who diagnosed her with
severe keratitis. Culture of
the tap water as well as
vitreous fluid would most
likely reveal:
A. Naegleria
B. Pneumocystis
C. Acanthamoeba
D. CMV
E. Toxoplasma
A 31-year-old man is brought C
to the ER because of rapid
onset of high fever, dyspnea
and malaise. He is
tachypneic and tachycardie.
Diagnosis of severe
pneumonia is made. His CD4
T cell count is found to be
133/microliter. Which of the
following is the most
accurate combination of
causing organism and the
appropriate treatment?
A. Candida albicans -
Amphotericin B
B. Pneumocystis jirovecii -
TMP/SMX (>200)
C. Toxoplasma gondii -
Azythromycin (> 100)
D. Cytomegalovirus -
Foscarnet (> 50)
E. Mycobacterium Avium
Complex (MAC) - Dapsone
(> 50)
A sexually active 17-year-old A
man presents to the local
free clinic to check some
small papules that appeared
on his penis. The papules are
small and white and contain
a central depression in their
center. There is no penile
discharge, nor is there pain
on urination. To what group
is the organism most likely
associated with?
A. Poxviridae
B. Papovaviridae
C. Adenoviridae
D. Parvoviridae
E. Arenaviridae
A 5-year-old girl is brought E
to the office because of
"pink eye." She was sent
home from kindergarten
yesterday by the school
nurse because her left eye
was red. When she
awakened this morning, the
right eye was red as well.
She has had watery drainage
but no purulent discharge.
She's had a mild head cold
with a runny nose and a mild
sore throat but no fever.
what is the most likely cause
of her condition?
A. Astrovirus
B. Entamoeba histolytica
C. Parainfluenza virus
D. CMV
E. Adenovirus
F. Toxoplasma
An 8-year-old sickle cell B
patient arrives at the
emergency room in
respiratory distress. Over the
previous several days, the
child has become
progressively tired and pale.
The child's hemoglobin
concentration in the
emergency room is 3.1
mg/dL (normal: 11-13 mg/dL)
Which of the following
viruses commonly causes
such a clinical picture?
A. Roseola
B. Parvovirus B-19
C. Coxsackie A-16
D. Echovirus 11
E. Respiratory syncytial virus
F. Evtomegalovirus