INFECTIOUS DISEASES
Questions 1-3
A 48-year –old male farmer from Arkansas presents with a 6-week history of
a slowly enlarging paranasal skin lesion, 10-pound weight loss, low-grade
fever, and a nonproductive cough. He has no underlying medical illness: On
examination he has a 6 x 4-cm right paranasal verrucous lesion that has a
heaped up, warty appearance with a violaceous hue. There is an area of
central healing. A chest radiograph reveals a 5 x 4-cm right parahilar
noncavitary mass lesion.
1.
What is the most likely diagnosis?
A. Squamous cell carcinoma
B. B. Histoplasmosis
C. Blastomycosis
D. Tuberculosis
E. Nocardiosis
2. A presumptive diagnosis in this patient can best be made through which
of the following?
A. Fungal serology
B. Blood cultures
C. Bronchoscopy with bronchoalveolar lavage and transbrochial biopsy
D. Bacterial, fungal, and mycobacterial cultures of the skin lesion
E. Skin biopsy with special stains for fungi and acid fast bacilli
3. Which therapy should be initiated in this patient?
A. Isoniazid, rifampin, and pyrazinamide
B. Itraconazole
C. Amphotericin B
D. Sulfisoxazole
E. Radiation therapy to the paranasal and lung lesion
Questions 4-5
A 30-year –old HIV-infected man presents with a 5-day history of altered
mental status and fever of 38.5o C. He has no history of an AIDS-defining
opportunistic infection. The patient is currently not on antiretroviral therapy.
On physical exam, the patient is obtunded but without focal neurologic
findings. There is no meningism. A computed tomography (CT) brain scan
reveals no mass lesions and no hydrocephalus. A lumbar puncture reveals an
opening pressure of 270 mm H2O, 8 WBCs (100% lymphocytes), 5 RBCs, protein
of 85 mg/dL, and glucose of 53 mg/dL. The India ink is positive, and the
cryptococcal antigen is 1:512.
4. Initial management of this patient should include
A. Immediate ventriculostomy
B. Flucytosine 150 mg/kg/day
C. IV amphotericin B 0.7 mg/kg/day
D. Intrathecal amphotericin B 1 mg day
E. Fluconazole 200 mg/day orally
5. The patient responds to therapy with improved cognitive function and lysis
of fever. Long-term management of this patient should include
A. Chronic suppression with oral fluconazole
B. Amphotericin B 0.6 mg/g/daily for 6 weeks, then observe off therapy
C. Repeat lumbar puncture at 4-week intervals, and continued daily
amphotericin B until cryptococcal antigen titers are 1:8 or less
D. Weekly IV amphotericin B 1 mg kg
E. Intermittent amphotricin B or fluconazole for evidence of clinical
relapse
Questions 6-7
A 32-year old black man presents with dysuria and a thick, purulent
urethral discharge 3 days after unprotected sexual intercourse with a new
female partner. The patient denies any other similar episodes, but he admits
to heterosexual promiscuity.
6.
What is the most useful initial diagnostic test in this patient?
A. Venereal Disease Research Laboratories (VDRL)
B. Urinalysis
C. Urethral Gram stain
D. Chlamydial antigen assay
E. Culture forNeisseria gonorrhoeae
7. A urethral Gram stain reveals multiple polymorphonuclear cells and
numerous intracellular gram-negative diplococci. What is the most
appropriate therapy?
A. Amoxicillin 3 g and probenecid 1 g PO, followed by doxycycline 100
mg bid for 7 days
B. Ceftriaxone 125 mg IM, followed by doxycycline 100 mg bid for 7 days
C. Ciprofloxacin 500 mg PO, followed by doxycycline 100 mg bid for 7
days
D. Procaine penicillin 4.8 million units IM, followed by doxycycline 100 mg
bid for 7 days
E. Both B and C are acceptable
Questions 8-10
A 44-year-old male engineer from India presents with a 2-week history of
fever and right upper quadrant pain. The patient lives in the United States but
visits his family in Bombay annually, and he returned from a visit 5 weeks ago.
The patient denies illness while in India, but he admits to a recent 7-pound
weight loss. Physical examination reveals a chronically ill appearing man with
fever (38.30 C) in moderate distress. There is moderate right upper quadrant
tenderness and moderate hepatomegaly but no splenomegaly. There are
no other physical findings. An abnormal ultrasonogram reveals a
noncalcified 7 x 6 –cm solitary mass in the right hepatic lobe. A plain
radiograph of the abdomen is normal.
8. Each of the following are possible causes for his current symptoms and
radiologic findings, except
A. Hepatoma
B. Pyogenic liver abscess
C. Amebic liver abscess
D. Echinococcal cyst
E. Metastatic carcinoma
9. The study that is most likely to be helpful in this patient is
A. Serum hepatitis B surface antigen
B. Stool ova and parasites
C. Serology of Echinococcus multilocularis
D. Serology of Entamoeba histolytica
E. Needle aspiration of hepatic lesion for Gram stain, culture, and cytology
10. Stool ova and parasites are negative: a serum indirect hemagglutination
assay for E. histolytica is positive 1:256. Appropriate therapy includes
A. Needle aspiration and drainage of the abscess
B. Metronidazole 750 mg tid for 10 days, then diloxanide furoate
C. Tetracycline 250 mg qid for 10 days, then diiodohydroxyquin
D. Clindamysin 800 mg tid for 10 days, then paromomycin
E. Thiabendazole
Questions 11-12
A 56-year-old male game warden living in Montana experiences sudden
onset of fever, headache, and photophobia. These symptoms last 3 days
followed by an asymptomatic period of 2 days and later by recrudescence
of fever and severe headache and myalgias. He reports several tick bites in
the preceding month, and he denies recent travel. His examination is
remarkable for fever (39.50 C) and minimal palpable splenomegaly. He has
no meningism, and his mental status is normal. There is no rash.
11. What is the most likely diagnosis?
A. Lyme disease
B. Rocky Mountain spotted fever (RMSF)
C. Relapsing fever
D. Colorado tick fever (CTF)
E. Dengue fever
12. What is the most appropriate therapy for this disorder?
A. Doxycycline 100 mg bid
B. Penicillin G 2 million units IV every 40
C. Ceftriaxone 2 g IV every day
D. Chloramphenicol 1 g IV every 60
E. No specific therapy is warranted
Questions 13-15
A 45-year-old man sustained a gunshot wound to the abdomen, leading
to a hemicolectomy, partial jejunal resection, and splenectomy. He is placed
on ampicillin, gentamicin, and clindamycin preoperatively. He becomes
afebrile on postoperative day 2, but fever develops again on day 6 to 390 C
without an apparent source. The patient is clinically stable. Peripheral WBC is
19,500 with a left shift. A subclavian vein central venous catheter has been
present since surgery. A chest roentgenogram is negative. Blood, urine, and
abdominal wound drainage cultures are obtained.
13. What is the best approach to anti-infective therapy at this time?
A. Add vancomycin to current regimen
B. Add fluconazole to current regimen
C. Add ceftazidime to current regimen
D. Stop current regimen and begin aztreonam and vancomycin
E. Stop all antibiotics
14. The patient remains clinically stable but persistently febrile. There are no
new clinical findings, and peripheral leukocytosis persists. Two of four
blood cultures drawn 48 hours earlier are positive for yeast. What is the
most appropriate intervention?
A. Replace central venous catheter over a guidewire; do not add
antifungal therapy.
B. Replace central venous catheter at a new site; begin antifungal
therapy
C. Do not manipulate central venous catheter; begin antifungal therapy
D. Begin antifungal therapy; schedule patient for abdominal CT scan
E. The blood cultures represent contamination; no intervention is
necessary
15. Candida glabrata is isolated from two blood cultures. Which of the
following is the best therapy in this clinical situation in a patient with
normal renal function?
A. Fluconazole 400 mg/day
B. Amphotericin B 0.6 mg/kg/day
C. Amphotericin B 0.6 mg/kg/day plus flucytosine 150 mg/kg/day
D. Amphotericin B 0.6 mg/kg/day plus fluconazole 400 mg/day
E. No specific antifungal therapy is necessary
Questions 16-18
Five months after exposure to a household case of active pulmonary
tuberculosis, a 28-year-old HIV-positive man presents with fever, chills, rash,
weight loss and nonproductive cough for 2 weeks. A CD4 count 3 months
ago was 380 cells/mm3. A chest roentgenogram reveals basilar interstitial
infiltrates without cavities, adenopathy, or pleural effusion. A purified protein
derivative test with controls reveals cutaneous anergy.
16. Which of the following is the most likely explanation for this illness?
A. Pneumocystis carinii
B. Cytomegalovirus (CMV)
C. Toxoplasma gondii
D. Streptococcus pneumoniae
E. Mycobacterium tuberculosis
17. The patient is placed empirically on parenteral cefotaxime, erythromycin,
and trimethoprim / sulfamethoxazole. Five days later, fever and
nonproductive cough continue, pulmonary infiltrates have progressed,
and the patient is clinically worse. What is the most appropriate
intervention?
A. Begin empiric IV ganciclovir
B. Add IV pentamidine; stop trimethoprim-sulfamethoxazole (TMO-SMX)
C. Begin empiric amphotericin B.
D. Begin empiric antituberculosis regimen; schedule bronchoscopy
E. Schedule open lung biopsy; continue current regimen
18. A bronchoaveolar lavage specimen reveals numerous acid-fast bacilli.
What is the appropriate therapeutic intervention?
A. Begin clarithromycin, ethambutol, and amikacin
B. Begin isoniazid and rifampin
C. Begin four-drug antituberculosis therapy
D. Begin six-drug antituberculosis therapy
E. Await culture results, and then start specific therapy
Question 19-20
A 20-year-old sexually active female college student presents with vaginal
irritation, scant discharge, and odor for 1 week. There is no dysuria. She
denies any history of sexually transmitted diseases.
19. Which of the following is the most likely cause of her current complaints?
A. Primary genital herpes
B. Trichomonas vaginitis
C. Candida vaginitis
D. Gonococcal cervicitis
E. Bacterial vaginosis
20. A vaginal exam reveals a thin, grayish, discharge with an unpleasant
odor, no genital lesions, and minimal cervical friability. Analysis of vaginal
secretions reveals the following: pH of 6.5 scant leukocytes, 3+clue cells,
and positive “whiff” test with addition of potassium hydroxide. No
trichomonads or yeast are seen microscopically. What is the likely
causative organism(s)?
A. Chlamydia Trachomatis
B. Herpes Simplex virus
C. N. gonorrhoeae
D. Mixed infection with Gardnerella vaginalis, Mobiluncus sp, and other
genital anaerobes
E. Ureaplasma urealyticum
Questions 21-22
A 69-year-old man with mild dementia is noted to have a serum VDRL titer
of 1:16, and a positive fluorescent treponemal antibody (FTA). The remainder
of his evaluation is negative, including a spinal fluid analysis, which reveals
normal protein and glucose, fewer than five leukocytes, and a negative
cerebrospinal fluid (CSF) VDRL. There is no history of prior treatment for
syphilis.
21. What is the most appropriate therapy?
A. Aqueous penicillin G 20 million units IV for 14 days
B. Procaine penicillin 600,000 units IM daily for 14 days
C. Benzathine penicillin 2.4 million units IM weekly for three doses
D. Ceftriaxone 2 g IV daily for 10 days
E. No therapy necessary
22. If the patient was allergic to ß-lactamase antimicrobials, what would be
the best alternative therapy?
A. TMP-SMX 160/800 mg bid for 30 days
B. Ciprofloxacin 500 mg bid for 30 days
C. Erythromycin 500 mg qid for 14 days
D. Doxycycline 100 mg bid for 30 days
E. Azithromycin 2 g single dose
Questions 23-25
An otherwise healthy 33-year-old man plans to join the Peace Corps and
will assigned to Thailand for 2 years. He is leaving in approximately 6 months
and has come to your clinic requesting pretravel advice and
recommendations regarding vaccination. On questioning, he states that all
of his vaccinations are “up to date” but cannot provide any specifics as to
when he received these vaccinations.
23. Which of the following is not a recommended vaccination in this patient?
A. Hepatitis A
B. Hepatitis B
C. Yellow fever
D. Tetanus
E. Oral polio vaccine
24. Which would be the most appropriate antimalarial prophylaxis provided
he remains in the urban areas of Thailand?
A. Doxycycline 100 mg daily
B. Chloroquine 300 mg weekly
C. Fansidar weekly
D. Mefloquine 250 mg weekly
E. No malaria prophylaxis necessary provided he remains in urban areas
of Thailand
25. Other suggestions for this patient would include each of the following,
except
A. Avoid undercooked seafood, raw vegetables, and unbottled drinks.
B. Avoid sexual intercourse, especially without the use of condom.
C. Consider pre-exposure rabies vaccination.
D. Begin norfloxacin 400 mg daily on entering the country to prevent to
traveler’s diarrhea.
E. If travel to rural areas occurs, use mosquito netting and
diethyltoluamide (DEET).
Questions 26-28
A 63-year-old man with chronic obstructive pulmonary disease (COPD)
presents to your office with a temperature as high as 102.50 F for 3 days,
nonproductive cough, headache, abdominal pain, and diarrhea. He has a
history of chronic alcoholism but no other underlying medical problems. On
exam, he is toxic appearing; BP is 110/170, heart rate is 95, respiratory rate is
32, temperature is 101.60 F. Chest exam reveals bilateral rales in the posterior
lower lung fields. Chest roentgenogram demonstrates bilateral patchy lower
lobe infiltrates, no effusion, and normal heart size. Laboratory results are as
follows:
WBC, 18,600; 90% polymorphonuclear leukocytes
(PMNs), 10% bands
Hematocrit (Hct), 35%
Arterial blood gases (room air) pH, 7.49; partial pressure of
Oxygen, 52 mm Hg; partial pressure of carbon dioxide, 28
mm Hg
Sodium, 132; potassium, 4.7; chloride, 110; bicarbonate, 28
Sputum Gram stain (induced): 3+ PMNs, are mixed organisms
26. What is the most likely cause of this condition?
A. Pseudomanas aeruginosa
B. M. tuberculosis
C. Legionella pneumophila
D. Haemophilus influenzae
E. Influenza A virus
27. What is the most appropriate initial therapy for this patient?
A. Ceftriaxone and erythromycin
B. Levofloxacin and nafcillin
C. Isoniazid and rifampin
D. Vancomycin and gentamicin
E. Rimantadine
28. Which of the following is most likely to be diagnostic in this case?
A. Routine sputum culture
B. Blood cultures
C. Urine for Legionella antigen
D. Sputum acid-fast bacillus smear and culture
E. Nasopharyngeal swab for viral culture
Questions 29-32
A 28-year-old woman presents with fever for the last 8 weeks. She admits
to low back pain and a 10-pound weight loss but has no other complaints.
She is otherwise healthy. On physical exam, she has a prominent holosystolic
murmur heard best at the apex with radiation to the axilla. No diastolic
murmur is heard. There is no rash, and the remainder of the exam is normal.
Laboratory results are as follows:
Hct 32%; WBCs 5200; 72 PMNs, 8 bands, 17 lymphs, 3 monos
Erythrocyte sedimentation rate: 81 mm/hour; electrolytes within
normal limits
Urinalysis 2 + RBCs., 1 + protein, 0 WBCs, Gram stain negative
29. What is the most appropriate diagnostic test at this time?
A. Blood cultures
B. Transthoracic echocardiogram
C. Transpharyngeal echocardiogram
D. Serology for Lyme disease
E. Abdominal CT scan
30. A diagnosis of endocarditis is established based on clinical findings and
positive blood cultures. Which of these organisms is most likely in this
patient?
A. Staphylococcus aureus
B. Escherichia coli
C. Group B streptococcus
D. Coagulase-negative staphylococcus
E. Streptococcus sanguis
31. There is no history of cardiac disease. What is the most likely underlying
valvular disorder?
A. Atrial septal defect
B. Mitral valve prolapse
C. Bicuspid aortic valve
D. Mitral stenosis
E. No underlying valvular disorder
32. Which of the following would be most appropriate initial therapy in this
patient assuming a fully susceptible organism?
A. Imipenem and gentamicin
B. Nafcillin
C. Vancomycin
D. Penicillin G
E. Cefriaxone and gentamicin
Questions 33-34
A 65-year-old man is hospitalized for elective surgery. Post-operative fever
develops at 380 C and two blood cultures are positive for S. aureus
susceptible only to vancomycin. His IV catheter is removed and replaced at
another site. He is febrile (38o C) and has a palpable cord in the right forearm
at a prior IV site, but otherwise has a normal physical exam. A transthorasic
echocardiogram is normal.
33. What is the likelihood of infective endocarditis in this patient?
A. Less than 10%
B. 25%
C. 50%
D. 75%
E. 100%
34. Assuming that the patient has repeatedly negative blood cultures, what is
the most appropriate therapy?
A. Vancomycin for 2 weeks
B. Vancomycin for 4 to 6 weeks
C. Vancomycin plus gentamicin for 2 weeks
D. Vancomycin plus gentamicin for 4 to 6 weeks
E. No need for therapy in a patient with transient S. aureus bacteremia
35. Which of the following conditions is characteristics of neurologic
involvement with HIV?
A. AIDS dementia complex
B. Vacuolar myelopathy
C. Peripheral sensory polyneuropathy
D. Aseptic meningitis
E. All of the above
36.
A 17-year-old high school student has recently experienced fever,
pharyngitis, and a positive throat culture for Streptococcus pyogenes. He
was given oral penicillin VK for 10 days and returns without symptoms. He
states that he took most of his medication. A repeat throat culture is
positive again. What is the most appropriate action?
A. No intervention is necessary
B. Give an additional 10-day course of penicillin VK to the patient
because he is clearly noncompliant.
C. Administer azithromycin 1 g
D. Administer ceftriaxone 250 mg
E. Administer penicillin VK to other family members to prevent secondary
cases
37. The majority of immunocompetent individuals who are acutely infected
with Toxoplasma gondii experience
A. Hepatitis
B. Lymphadenopathy
C. Heterophile-negative mononucleosis
D. Fever and debilitating fatingue
E. No symptoms
38. Hand-foot-and-mouth disease and herpangina are most commonly
causes by strains of
A. Group A coxsackievirus
B. Group B coxasackievirus
C. Echoviruses
D. Enteroviruses
E. Adenoviruses
39. The gram-negative organism which is the least likely cause of infective
endocarditis (IE) on a native valve is
A. Cadiobacterium hominis
B. Haemophilus aphrophilus
C. E. coli
D. Eikenella corrodens
E. Actinobacillus actinomycetem comitans
40. All of the following persons are at increased risk of skin colonization with S.
aureus, except
A. Patients on hemodialysis for chronic renal failure
B. IV drug abusers
C. Insulin-dependent diabetes
D. Patients with atopic dermatitis
E. IgA-deficient patients
41. A 26-year-old male student complains of abdominal cramps, belching,
excess flatus, and watery diarrhea for 6 weeks after a 1-month tour of
Russia. He describes no fever but has lost 12 pounds. Which of the
following organisms likely explains his symptoms?
A. Cryptosporidium parvum
B. Giardia lamblia
C. Enterotoxigenic E. coli
D. Salmonella enteritidis
E. Shigella sonnei
42. Which of the following antimicrobial agents is not associated with
increased anticoagulation among patients receiving warfarin?
A. Rifampin
B. Sulfonamides
C. Chloramphenicol
D. Cefotetan
E. Isoniazid
43. Which of the following statements about pneumococcal pneumonia are
not true?
A. Most cases are not bacteremic
B. The most important virulence factor is penicillin resistance
C. Risk factors for disease include sickle-cell disease, multiple myeloma
and HIV infection
D. Untreated morality may exceed 20%
E. The drug of choice for high-level penicillin-resistant S. pneumoniae is
ceftriaxone among patients with pneumonia
44. Established pathogens among human mycoplasma include each of the
following, except
A. Mycoplasma hominis
B. M. fermentans
C. M. urealyticum
D. M. lipophilum
E. M. penetrans
45. What is the most common cause of community acquired meningitis in
adults?
A. H. influenzae
B. N. meningitis
C. S. pneumoniae
D. Group A streptococcus
E. S. aureus
46. Which of the following Salmonella sp is likeliest to cause endarteritis?
A. S. enteritidis
B. S. typhi
C. S. paratyphi
D. S. choleraesuis
E. S. hirschfeldii
47. Which of the following Bartonella sp is the most common cause of
endocarditis?
A. B. baciliformis
B. B. quintana
C. B. henselae
D. B. elizabethae
E. B. cinsoni
48. Which of the following statements concerning M. tuberculosis is not true?
A. Sputum cultures may remain positive for weeks after effective therapy
B. Among patients with untreated cavitary pulmonary disease, a
negative sputum smear for acid-fast bacilli is unusual
C. Extrapulmonary tuberculosis occurs in about 30% of non-HIV –infected
patients
D. Lifelong risk of clinical tuberculosis is less than 10% in HIV-negative, skin
test-positive patients
E. HIV-infected patients with clinical tuberculosis generally do not require
chronic suppressive antimycobacterial therapy after effective
treatment
49. Which statement about Q fever (Coxiella burnetii) is true?
A. It is worldwide pathogen
B. Most cases present with acute pneumonia syndrome.
C. Inhalation of spores leads to infection
D. Rash in characteristic of Q fever
E. Endocarditis occurs in men with pre-existing valve disease
50. Which of the following antiviral agents is/are not effective for the
treatment of CMV retinitis?
A. Acyclovir
B. Ganciclovir
C. Foscarnet
D. Cidofovir
E. All are effective
51. Which of the following syndromes is the most common presentation for
CMV disease in a recent renal transplant recipient?
A. Mononucleosis-like illness
B. Pneumonia
C. Encephalitis
D. Hepatitis
E. Chorioretinitis
52. Diseases associated with Epstein-Barr virus (EBV) include all of the
following, except
A. Heterophil-positive mononucleosis
B. Nasopharyngeal carcinoma
C. Chronic fatigue syndrome
D. B-cell lymphoma in transplant recipients
E. Burkitt’s lymphoma
53. Which is the least efficient means of HIV transmission from an HIV-infected
patient?
A. Accidental needle exposure
B. Heterosexual intercourse
C. Receptive anal intercourse
D. Deep kissing
E. Active anal intercourse
DIRECTIONS: For questions 54-91, decide whether each statement is true or
false. Any combination of answers, from all true to all false, may occur.
54. A 38-year-old black man with long-standing sarcoidosis and pulmonary
fibrosis presents with a 2-week history of cough, hemoptysis, low-grade
fever, and weight loss. He has been on corticosteroids intermittently for
the last 10 years but none in the last 2 months. On physical exam, he
appears chronically ill and has diffuse inspiratory rales. A chest
radiograph reveals apical pulmonary fibrosis with bilateral apical lesions
compatible with aspergillomas (mycetomas). Which of the following
statements regarding his disease is/are true?
A. Life-threatening hemoptysis may occur in the absence of surgical
removal of the involved lobes.
B. Systemic amphotericin is warranted to eradicate the mycetomas
C. Spontaneous regression occurs in 50% of mycetomas
D. The diagnosis of mycetoma is primarily radiographic
E. Itraconazole has proven efficacy in the treatment of pulmonary
mycetoma
55. The following are characteristic complications of infection with
Plasmodium falciparum:
A. Acute renal failure
B. Diarrhea
C. Pulmonary edema
D. Coma
E. Pancreatitis
56. Characteristics consistent with Plasmodium malariae infection include
A. Seizures
B. Marked splenomegaly
C. Primaquine required to eradicate extraerythrocytic phase
D. Nephrotic syndrome
E. Low-grade parasitemia
57. Early valve replacement must be strongly considered in a patient with IE
under the following circumstances:
A. S. aureus tricuspid endocarditis
B. Congestive heart failure complicating IE
C. Persistently positive blood cultures
D. Fungal IE
E. Extension of infection into the mycordium
58. Risk factors for the development of reactivation infection with M.
tuberculosis include
A. Race
B. Malnutrition
C. Silicosis
D. Chronic renal failure
E. Age
59. Poor prognostic indicators among patients with cryptococcal meningitis
include the following:
A. Obtundation
B. High CSF cryptococcal antigen titer
C. Underlying immune deficiency
D. Headache
E. CSF WBC count > 20 cells/mm3
60. Which of the following statements about Hansen’s disease (leprosy) are
true?
A. Hansen’s disease is highly contagious to household contacts.
B. M. leprae is easily cultivated in laboratory media.
C. Lepromatous leprosy may result from a selective T-lymphocyte
responsiveness to M. leprae antigen.
D. Palpable peripheral nerves are usually found in patient with
lepromatous leprosy.
E. Large numbers of organisms are characteristic in lesions of polar
tuberculoid leprosy.
61. The differential diagnosis of pelvic inflammatory disease includes the
following:
A. Appendicitis
B. Hemorrhagic ovarian cyst
C. Ectopic pregnancy
D. Ovarian torsion
E. Endometriosis
62. Which of the following organisms have been commonly linked to acute
and chronic salpingitis?
A. N. gonorrhoeae
B. C. trachomatis
C. Bacteroides sp
D. Aerobic gram-negative rods
E. S. aureus
63. The following are complications associated with salpingitis:
A. Infertility
B. Ectopic pregnancy
C. Ovarian cysts
D. Chronic pelvic pain
E. Abnormal uterine bleeding
64. The following are characteristic of disseminated gonococcal infection:
A. Mostly occurs in females
B. Diffuse pustular rash, usually with > 100 lesions
C. Organisms usually seen in Gram stain of joint fluid
D. Most patients culture negative
E. May cause rapidly progressive IE
65. Which of the following statements are true about human ehrlichiosis?
A. Most cases are tick-borne.
B. There are at least two Ehrlichia species that cause human disease
C. The disease is as least as severe as RMPSP.
D. The disease is particularly common in the western United States
E. Tetracycline or doxycycline is the drug of choice.
66. Combination antimicrobial therapy is warranted under the following
circumstances:
A. Uncomplicated viridans streptococcal endocarditis
B. Enterococcal endocarditis
C. Fever in the neutropenic patient
D. S. aureus bacteremia resulting from contaminated central venous
catheter
E. E. coli bacteremia complicating pyelonephritis
67. Which of the following statements regarding infection with Borderella
pertussis are true?
A. Nonimmune household contacts disease less then 50% of the time
B. Vaccination and/or natural infection confer lifelong immunity.
C. Marked peripheral lymphocytosis is characteristic of acute infection
D. Proctracted convalescent stage sometimes lasting 3 months is
common
E. Treatment with erytromycin in the paroxysmal stage clearly ameliorates
symptoms and shortens the duration of the disease.
68. Which of the following are true regarding human infection with
Francisella tularensis?
A. Ticks are a major vector.
B. Pneumonia may result from skinning or eviscerating an infected rabbit
C. Infection may mimic disease caused by Sporothrix schenkii.
D. Diagosis is usually based on isolates from blood cultures.
E. Ceftriaxone is the drug of choice for systemic disease
69. The following are characteristic of nocardiosis:
A. Underlying host usually has impaired humoral immunity.
B. Nocardiosis is associated with multiloculated brain abscesses.
C. Isolation from sputum may occur in the absence of radiographic or
clinical disease.
D. Multiple organ involvement is common, especially in
immunocompromised hosts.
E. Sulfur granules are often seen in clinical specimens from involved sites.
70. The following should receive influenza vaccine routinely:
A. Persons aged 65 years or older
B. Physicians nurses and other health care workers
C. Nursing home residents
D. Solid organ transplant recipients
E. Anyone wishing to reduce the risk of influenza
71. Which of the following Plasmodium sp have a chronic intrahepatic
stage?
A. P. malariae
B. P. ovale
C. P. vivax
D. P. falciparum
72. A traveler returning from West Africa has fever, severe headache, and
anemia. A diagnosis of falciparum malaria is made. The following are
appropriate therapies:
A. Chloroquine
B. Mefloquine
C. Quinine
D. Halofantrine
E. Pyrimethamine plus sulfadoxine
73. The following cytokines are frequently associated with induction of fever:
A. Tumor neurosis factor-
B. Tumor neurosis factor-ß
C. Interleukin-6
D. Interferon-
E. Interferon-ß
74. The following are increased as an acute-phase response:
A. C-reactive protein
B. Ceruloplasmin
C. Alpha-antitrypsin
D. Albumin
E. Ferritin
75. The following conditions are associated with a significantly increased risk
of serious bacterial infection:
A. Splenectomy
B. IgG deficiency
C. Hairy cell leukemia
D. Deficiency of complement factors C1, C2, C4
E. Neutropenia (PMNs < 1000 cells/mm3)
76. Which of the following statements concerning nosocomial infections are
true?
A. Candida sp are the fourth leading cause of nosocomial blood stream
infections.
B. Urinary tract infections are the most common cosocomial infections.
C. Overall, Pseudomonas aeruginosa is the most common cause of
nosocomial infection.
D. Wound infections are most commonly cause by S. aureus.
E. The attributable mortality of nosocomial pneumonia exceeds 50%.
77. Which of the following are major criteria in the diagnosis of acute
rheumatic fever?
A.Arthritis
B.Carditis
C.Erythema marginatum
D.Subcutaneous nodules
E.Fever
78. Ticks are important vectors in the transmission of the following organisms:
A. Rickettsia akari
B. Rickettsia rickettsii
C. F. tularensis
D. Coxiella burnetii
E. Rickettsia prowazekii
79. The following are characteristic of bacterial vaginosis:
A. pH of 4.5
B. Clue cells
C. Odor with potassium chloride
D. Sheets of PMNs
E. White curd
80. Which of the following are true concerning the acute urethral syndrome?
A. Pyuria is always present
B. Bacterial colony counts are usually < 104 per milliliter voided urine.
C. C. trachomatis is a common cause.
D. Fever and dysuria are common symtoms.
E. S. saprophyticus is a common cause.
81. Which of the following statements regarding gonococcal infections are
true?
A. Gonococcal urethritis is the most common form of urethritis in adult
males.
B. Most women with gonococcal cervicitis are symptomatic.
C. Cervical culture is the most sensitive method of diagnosis in women.
D. Disseminated gonococcal infection occurs in about 1% of adults with
gonorrhea.
E. A first episode of gonococcal salpingitis leads to infertility in about 30%
of women.
82. The following statements concerning Lyme disease are correct:
A. The disease is transmitted person to person.
B. Dermatologic findings are the most common.
C. Cardiav involvement is early and is associated with heart failure.
D. Amoxicillin or doxycycline for 21 days is an effective regimen for early
disease.
E. An effective vaccination for Lyme disease is available.
83. The following agents are fungistatic:
A. Amphotericin B
B. Nystatic
C. Ketoconazole
D. Fluconazole
E. Itraconazole
84. The following individuals are at enchanced risk for disseminated
histoplasmosis:
A. Infants
B. All HIV-positive individuals
C. Solid organ transplant recipients
D. Chronic alcoholics
E. Individuals with COPD
85. The following statements about coccidioidomycoses are true?
A. Most cases of primary disease are asymptomatic.
B. The most common pulmonary complication is progressive fibrocavitary
disease.
C. Serology is unhelpful in diagnosis.
D. Pregnant women are at increased risk of dissemination.
E. Risk of disseminated disease is associated with race.
86. The following statements about cryptococcosis are true:
A. The disease is restricted to North America, Western Europe, and Africa.
B. All patients with extrapulmonary disease have a measurable
immunologic disorder.
C. It is the most common fungal CNS infection.
D. Patients with pulmonary disease require surgical resection.
E. A positive cryptococcal antigen in the CSF is diagnostic for CNS
disease.
87. For the following forms of aspergillosis, there is good clinical evidence to
support the efficacy of systemic antifungal therapy:
A. Pulmonary aspergillomas
B. Otitis external
C. Chronic necrotizing aspergillosis
D. Disseminated adpergillosis
E. Allergic alveolitis
88. Which of the following statements about pneumocystosis are true?
A. Only HIV-infected patients with low CD4 lymphocytes (<200 cells/mm3)
are at risk for Pneumocystis carinii pneumonia (PCP).
B. Cavitary lung disease is a common complication of PCP.
C. Glucocorticosteroids are warranted in selected patients with PCP.
D. TMP-SMX is the treatment of choice for acute disease.
E. There is good evidence to support person-to-person transmission.
89. Which of the following neoplasias are associated with an increased
incidence among HIV-infected patients?
A. Anal carcinoma
B. Hodgkin’s disease
C. Non-hodgkin’s lymphoma
D. Nasopharyngeal carcinoma
E. Cervical carcinoma
90. The following are potential causes for CD4 cell depletion in HIV-infected
persons:
A. Apoptosis
B. Syncytia formation
C. Autoimmune destruction
D. Direct toxicity of HIV
E. Impaired regeneration
91. The following cells are typically infected by HIV:
A. CD4
B. CD8
C. Langerhan’s cells
D. Microbial CNS cells
E. Tissue macrophages
DIRECTIONS: Questions 92-172 are matching questions. For each numbered
item, choose the most likely associated item from those provided. Within
each set of questions, each answer may be used once, more than once, or
not at all.
Match the organism and the characteristic genital ulceration:
A. Herpes simplex virus
B. Treponema pallidum
C. Haemophilus ducreyi
D. Calymmatobacterium granulomatis
92. Extensive painless ulceration in the groin with pseudobuboes
93. Painless ulceration with induration
94. Painful shallow ulceration with associated systemic symptoms, including
headache, nausea, vomiting, and fever
95. Painful undermined ulceration with soft edges and associated buboes
Match the retroviruses with the appropriate clinical description.
A. Human T-cell leukemia virus (HTLV)-1
B. HTLV-2
C. HIV-1
D. HIV-2
96. AIDS-like illness geographically restricted to West Africa, India, and rarely,
Western Europe
97. Tropical spastic paraparesis
98. Adult T-cell leukemia/lymphoma
99. In certain regions of sub-Saharan Africa, 20 to 40% of childbearing
women infected
Match the virus with the syndrome described.
A. Yellow fever
B. Dengue
C. Sin nombre
D. Lassa
100. Adult respiratory distress syndrome and hypotension in a resident of Utah
101. Hemorrhagic complications and severe disease more likely in previously
infected persons
102. Person-to-person transmission well documented
103. Fever, jaundice, and gastrointestinal bleeding in a severely ill man
returning from the Amazon region.
Match each of the nontuberculous mycobacteria (NTM) with the appropriate
description.
A. Mycobacterium avium-intracellulare
B. Mycobacterium kansasii
C. Mycobacterium marinum
D. Mycobacterium abscessus
E. Mycobacterium gordonae
104. Most common cause of NTM lymphadenitis
105. Rapidly growing NTM; may cause cutaneous, pulmonary, or
disseminated disease.
106. Cutaneous ulcer in a fisherman
107. Pulmonary infection resembles M. tuberculosis, but therapy is isoniazid,
rifampin, and ethambutol for 18 months
108. Rarely a human pathogen, usually indicative of environmental
contamination
Match the following defects in host immunity with the most appropriate
infectious complication.
A. Neutropenia
B. Decreased cell-mediated immunity
C. Immunoglobulin A deficiency
D. Complement deficiency
E. Asplenia
109. L. pneumophila in a renal transplant patient
110. Severe babesiosis
111. Chronic giardiasis
112. Recurrent meningococcal disease
113. Hepatosplenic candidiasis
114. Overwhelming
pneumococcal bacteremia
115. P. aeruginosa bacteremia
Match the following trypanosomes with the correct clinical description.
A. Trypanosoma brucei brucei
B. Trypanosoma brucei rhodesiense
C. Trypanosoma brucei gambiense
D. Trypanosoma cruzi
116. Megasophagus with achalasi, recurrent aspiration pneumonia
117. Winterbottom’s sign followed by chronic encephalopathy
118. High temperature, rapid neurologic deterioration, evidence of
disseminated intravascular coagulation
119. A nonhuman pathogen that causes wasting illness in cattle and wild
animals
Match each arthropod-borne virus with the appropriate clinical desscription.
A. Western equine encephalitis
B. Eastern equine encephalitis
C. St. Louis encephalitis
D. California encephalitis
120. Likelihood of apparent disease is greatest in early childhood; overall
mortality is 3 to 5%, mostly in children younger than 5 years.
121. Likelihood of apparent disease increases with age; fatality rare in
patient younger than 20 years, approximately 30% in patient 65 or older.
122. Epizootics in horses and exotic birds precede human epidemics; case
fatality rate is 35 to 50%.
123. Disease affects younger individuals living in rural areas with close
proximity to deciduous hardwood forest; case fatality rate less than 1%.
Match the rickettsial organism with the appropriate clinical or epidemiologic
features.
A. Rickettsia conorii
B. R. akari
C. R. rickettsii
D. R. typhi
E. R. prowazekii
F. C. burnetii
G. Ehrlichia equi
124. Humans are infected through body louse feces; symptoms recur years
after primary illness.
125. This is associated with tache noire.
126. Rash is uncharacteristic.
127. This is associated with rodent reservoir, truncal rash, moderate illness
128. This is associated with mouse reservoir, papulovesicular rash, sekf-limited
illness.
129. This is associated with severe headache, history of tick exposure,
petechial rash, multisystem involvement.
Match the following organisms and the clinical syndrome.
A. Enterotoxigenic E. coli
B. S. enteritidis
C. S. sonnei
D. S. typhi
E. Campylobacter jejuni
F. G. lamblia
130. A 19-year-old man with crampy abdominal pain and watery diarrhea
for 3 weeks after a camping trip.
131. A 42-year-old woman with a 2-day history of abdominal pain, watery
diarrhea, and temperature of 100.50 F she just returned from a-day tour
of Guatemala.
132. An 18-month old boy with acute-onset bloody diarrhea, seizures, and
temperature to 1020. He attends a day care facility.
133. A 35-year-old woman with fever, abdominal pain, and constipation
lasting 10 days. She recently visited her family in a small village in Peru.
134. A 70-year-old woman with blood-streaked diarrhea, abdominal pain,
hypotension, and positive blood cultures. She has had no recent travel
and lives alone.
Select the appropriate gram-positive organism for each of the clinical
descriptions listed.
A. Erysipelothrix rhusiopathiae
B. Actinomyces israelii
C. Nocardia asteroides
135. A 37-year-old male alcoholic with chronic necrotizing pneumonia
involving the left lower lobe experiences erythema and fluctuation over
the left lateral chest wall; this spontaneously drains purulent, non-foulsmelling material that contains a yellowish granular substance.
136. A 53-year-old female insulin-requiring diabetic has a recent history of
right upper lobe pneumonia, which has resolved; she now presents with
altered mental status and fever; CT brain scan reveals a left frontal
multiloculated mass with surrounding brain edema.
137. A 63-year-old male butcher acquires a purpllish, painful, somewhat
indurated ulceration over is left index finger; there is no fever or systemic
symptoms.
Select the primary immunodeficiency that is most consistent with each of the
cases.
A. Chronic granulomatous disease
B. Myeloperoxidase deficiency
C. Common variable immunodeficiency
D. Absent C7
E. IgA deficiency
138. A 23-year-old man with chronic giardiasis and recurrent sinusitis; total
serum immunoglobulin levels are normal
139. A 34-year-old woman with a second episode of meningococcal
meningitis; her first episode was 2 years ago.
140. A 45-year-old man with chronic diarrhea and bronchiectasis; he was
recently found to be hypogammaglobulinemic
141. A 5-year-old boy with recurrent staphylococcal skin and pulmonary
infections who presents with pain, swelling, and erythema in the left
distal femur; radiographs of the femur reveal changes compatible with
osteomyelitis
142. A 28-year-old woman who is asymptomatic and has a history of
recurrent infectons
For each of the clinical descriptions, select the most likely cause.
A. Angiostronglus cantonensis
B. Strongyloides stercoralis
C. Ascaris lumbricoides
D. Enterobius vermicularis
E. Toxocara canis
143. Hepatomegaly, fever, and eosinophilia in a 4-year-old
144. Pruritus ani in a 24-year-old mother of three small children
145. Intestinal obstruction in a 5-year-old-boy
146. Eosinophilic meningitis after ingestion of under-cooked snails
For each fungal organisms select the appropriate microscopic morphology.
A. Large spherules (75 µm) containing endospores
B. Budding yeasts with pseudohyphae
C. Multiple budding “pilot wheel” yeast
D. Small (2-6 µm) cigar-shaped budding yeast
E. Broad-based budding yeast with refractile cell walls
F. Small (4-6 µm) budding yeast with large polysaccharide capsule
147. Sporothrix schenckii
148. Blastomyces dermatitidis
149. Coccidioides immitis
150. Paracoccidiodes brasiliensis
151. Candida albicans
152. Cryptococcus neoformans
Match the following malaria parasite with the appropriate characteristic.
A. P. vivax
B. P. falciparum
C. Plasmodium malariae
D. Plasmodium ovale
153. High level of parasitemia associated multiple-organ failure and high
mortality
154. Chronic splenomegaly and nephrotic syndrome
155. No known chloroquine resistance
156. Sporadic reports of chloroquine resistance, generally a benign clinical
cause
Match the following characteristics of staphylococci with the appropriate
clinical condition.
A. Preformed staphylococcal toxin
B. Toxin produced after colonization/infection
C. Coagulase-negative staphylococci
D. Infection may occur after trauma
157. HIV-infected patient with pain and swelling in anterior thigh
158. Nausea and vomiting 6 hours after a picnic
159. Fever and a new cardiac murmur in a patient with a prosthetic aortic
valve placed 1 month ago
160. Fever, hypocalcemia, and diffuse erythematous rash in patient with a
wound infection
Match the following organisms with the appropriate description.
A. Leishmania donovani
B. T. gondii
C. Taenia solium
D. Schistosoma mansoni
E. Strongyloides stercoralis
F. T. canis
167. Fever, significant eosinophilia, and rash in a 5-year-old boy
168. Massive hepatosplenomegaly and pancytopenia without eosinophilia in
a 30-year-old Indian woman
169. Calcified intravascular and intracerebral lesions in an otherwise healthy
25-year-old Mexican man
170. A mononucleosis-like illness in an otherwise healthy 15-year-old girl
171. Abdominal pain, E. coli bacteremia, and respiratory failure in a 65-yearold man with steroid-dependent asthma
172. Chronic dermatitis and progressive blindness in a 45-year-old man from
West Africa