Download 1 - USMF

1. Note the correct answer regarding Bacillus anthracis:
 Spores are quickly destroyed in soil
 B anthracis is gram-positive rods
 The anthrax toxin consists of three distinct antigenic components
 The organism generally exists in the endospore form in nature
 B anthracis is found in soil only in equatorial Africa
2. Note the correct answer regarding antrax modes of transmission:
 Anthrax primarily is a disease of herbivores
 Illness in humans most commonly occurs following contact with infected humans
 Bacillus anthracis can be used as a Bioterrorist Weapon
 Consumption of contaminated undercooked meat can lead to cutaneous anthrax
 Cases following laboratory exposure have been recognized
3. Note the wrong answer regarding the clinical features in cutaneous antrax:
 Ulcer is surrounded by a satellite vesicles and edematous halo
 Ulcer is painful with a black eschar
 Regional lymphadenopathy may be painful
 The membrane/exudate of the ulcer contains numerous anthrax bacilli
 There is relatively large extent of associated edema
4. Note what is not characteristic for oropharyngeal anthrax:
 Patients may complain of unilateral sore throat/difficulty swallowing
 The ulcer may be accompanied by a membrane
 The ulcer may be is associated with local edema and cervical adenopathy.
 On chest radiograph can be revealed mediastinal widening
 Death may result from asphyxiation due to neck edema or toxemia
5. Note what is characteristic for intestinal anthrax:
 Patients complain of vomiting, severe abdominal pain, hematemesis, bloody diarrhea, fever.
 Primary intestinal anthrax has a local lesion resembling the ulcer of oropharyngeal anthrax
 Multiple anthrax ulcerative lesions are found throughout the GI tract secondary to hematogenous
spread.
 Intestinal anthrax is not difficult to recognize
 Case-fatality rate where patients received antibiotic therapy remain very high
6. Note what is characteristic for inhalational anthrax:
 There is no fatality where patients received antibiotic
 Incubation period is 1-60 days in weapon-grade anthrax
 Illness may be biphasic with an initial prodrome followed by severe respiratory distress
 Inhalational anthrax presents as hemorrhagic mediastinitis
 Multiple anthrax ulcerative lesions are found in oropharyngs
7. Note what is not characteristic for anthrax:
 Patients with inhalational anthrax have a good prognosis
 Patients with septicemic anthrax may develop overwhelming toxicity or shock
 Postexposure prophylaxis for bioterrorist anthrax should be continued for 60 days
 Hemorrhagic meningoencephalitis is a characteristic presentation of CNS lesion in antrax
 Intravenous administration of antibiotics is recommended in cases of gastrointestinal antrax
8. Note what is characteristic for anthrax:
 The availability of anthrax vaccine is limited to military personnel
 If treated early, patients with cutaneous anthrax have a good prognosis
 Gram stain of CSF reveals many gram-negative diplococcal
 In inhalational antrax abnormal chest radiograph can reveal mediastinal widening, infiltrates,
consolidation and pleural effusion.
 Person-to-person transmission is recognized in inhalational disease
9. What clinical scenario is not characteristic for antrax:
 Cutaneous anthrax
 Oropharyngeal anthrax
 Inhalational anthrax
 Kidney antrax

Intestinal anthrax
1. What is not correct regarding Clostridium botulinum :
o Cl. botulinum are spore-forming, anaerobic bacillus
o Cl. botulinum may exist in soil or marine sediments throughout the world
o Clostridial spores are highly heat resistant
o The toxin is heat labile
o Botulism is a disease caused by spores of Cl. botulinum
2. Note the correct answer regarding botulism pathogenesis:
o The toxin causes blockade of neuromuscular conduction
o The toxin causes demielinisation
o Blockade of neurotransmitter release at the nerve terminal is considered permanent
o Botulism is a disease caused by the neurotoxins of Clostridium botulinum
o The toxin causes direct cytolysis of endothelial cells
3. Name the 3 clinical scenarios of botulism disease:
o Food poisoning botulism
o Wound infection botulism
o Kidney botulism
o Respiratory botulism
o Infant botulism
4. Note the correct answer regarding botulism disease
o The onset of symptoms can be abrupt or can evolve over several days
o Typically, patients are febrile
o Patients generally remain alert and responsive
o Abdominal pain, with nausea and vomiting may precede or follow paralysis
o The patients generally have hypersalivation
5. What is not characteristic for ophtalmoplegia syndrome in botulism:
o Mydriasis - pupil dysfunction with poorly reactive pupils
o Diplopia (double vision)
o Lacrimation
o Anisocoria - lesion of the nn.ciliares breves
o Blepharoptosis - lesion of the III nerve
6. What is not characteristic for pharyngal neuropathic and glottal neuropathic syndroms in botulism:
o Dysphagia - impairment of swallowing and drinking
o Impairment of the palatinate reflex
o Blepharoptosis - lesion of the III nerve
o Dysphonia
o Hoarse voice
7. What syndromes can be revealed in botulism:
o Ophtalmoplegia syndrome
o Pharyngal neuropathic syndrome
o Muscular (miastenia) syndrome
o Meningitis syndrome
o Toxic shock syndrome
8. What syndromes can be revealed in botulism:
o Hypovolemia shock
o Gastrointestinal syndrome
o Respiratory difficulties
o Ophtalmoplegia syndrome
o Encephalitic syndrome
9. What syndrome is not characteristic for non severe form of botulism:
o Gastrointestinal syndrome
o Respiratory difficulties
o Pharyngal neuropathic syndrome
o Ophtalmoplegia syndrome
o Muscular (miastenia) syndrome
10. What is not characteristic for muscular (miastenia) syndrome in botulism:





Muscle weakness
A generally symmetric descending flaccid paralysis
Paralytic ileus advancing to severe constipation and urinary retention.
Convulsions
Gastric dilation
11. What is not characteristic for wound botulism:
o The number of patients with WB and a history of chronic intravenous drug abuse has increased
o Patients may be febrile, but this is more likely due to the wound infection rather than the WB
syndrome
o Often, the wound appears quite benign
o Wound botulism is the rarest form of botulism
o Gastrointestinal symptoms are always present in wound botulism
12. Note the correct answer regarding botulism disease:
o The diagnosis of botulism requires a high degree of clinical suspicion
o Wound infection requires incision and thorough debridement of the infected wound
o Urinary catheterization may be required for urinary retention
o Stomach and intestinal irrigation is not required
o The demonstration of toxin in serum involves a bioassay in mice
13. Note the correct answer regarding botulism treatment:
o Mechanical ventilation is considered when vital capacity is less than 30% of predicted.
o Antitoxin will neutralize toxin already bound to neuromuscular junctions
o Stress ulcer prophylaxis also is a standard component of intensive care management
o An antitoxin may be beneficial, even when provided several wk after toxin ingestion
o The antitoxin should be given after receiving laboratory confirmation of diagnosis.
14. Note the correct answer regarding botulism treatment:
o HBIG - human botulinum immune globulin, ("Baby-BIG") is benefical for infant botulism
o Botulism (infant and wound) should be treated with antibiotics to stop toxigenesis
o Antitoxin has effect on established neurologic deficits.
o Botulism antitoxin is an equine antitoxin
o Equine antitoxin frequently is used in infant botulism
1. What Brucella species do not cause Brucellosis in humans?:
 Brucella melitensis
 Brucella abortus bovis
 Brucella ovis
 Brucella suis
 Brucella canis
2. Note the correct answer regarding Brucella species:
 coccobacill
 diplococcal
 gram-negative
 intracellular aerobes
 intracellular anaerobs
3. Note the correct answer regarding Brucellosis transmission:
 transmission occurs through direct contact with animals, their carcasses or excreta, or by-products
of abortion
 infection may penetrate through damaged skin
 can be directly transmitted from human to human
 transmission occurs through ingestion of contaminated food products
 transmission occurs through sexual contact
4. Note the correct answer regarding Brucellosis:
 Brucellosis is a frequent entity in many industrialized nations
 Symptoms of brucellosis are protean in nature, and none are specific enough to make the
diagnosis
 Brucella do not survive well in aerosols and do not resist drying
 Brucellosis do not cause chronic forms
 Standard culturing techniques require short incubation periods
5. Note the correct answer regarding clinical manifestation of Brucellosis:
 Lung infection is very common
 Congestive cardiac failure is characteristic for the young people
 Fever (intermittent, undulant) can be associated with: chills, sweats and relative bradycardia
 Neuropsychiatric symptoms consist of headache, depression, fatigue, emotional instability,
irritability
 Pain in the spine is an early and constant symptom, either in the neck or over the lumbar area
6. Note the correct answer regarding clinical manifestation of Brucellosis:
 Orchitis and epididymitis are not characteristic
 Urinary infections have no distinguishing features (pyelo- and glomerulonephritis may
develop).
 Cirrhosis is a frequent manifestation
 Abdominal tenderness is associated with enlargement of the liver and/or the spleen.
 Osteoarticular findings are characterized by tenderness, swelling over affected joints, bursitis,
decreased range of motion
7. Note the correct answer regarding Brucellosis:
 Osteoarticular, genitourinary, and hepatosplenic involvement are most common complications
 Radiographic findings in patients with osteoarticular disease occur early in the course of illness
 Radionuclide scintigraphy is not sensitive for detecting skeletal abnormalities
 Monotherapeutic antimicrobial regimen is the mainstay of therapy
 This disease is easily curable with antiviral treatment
8. Note the correct answer regarding treatment of Brucellosis
 Multidrug antimicrobial regimens are the mainstay of therapy
 Monotherapeutic approaches has a high relapse rates
 Drugs displaying clinical activity against Brucella spp. are doxycycline, gentamicin, rifampin
 Drugs displaying clinical activity against Brucella spp. are penicylline, erytromycine
 Despite appropriately treated within the first months of onset, the infection has a very high risk of
relapse or chronic disease.
1. Note the wrong answer regarding viral hepatitis
 VHA is an DNA virus
 VHB is an DNA virus
 VHE is an RNA virus
 VHD is an RNA virus
 VHC is an RNA virus
2. Note the wrong answer regarding viral hepatitis
 Major transmission of virus in VHA is by fecal-oral way
 Major transmission of virus in VHB is by sexual or by parenteral way
 Major transmission of virus in VHC is by parenteral way
 Major transmission of virus in VHE is by parenteral way
 Major transmission of virus in VHD is by sexual or by parenteral way
3. Note the correct answers regarding viral hepatitis
 The chronicity rate in VHA is <10%
 The chronicity rate in VHD superinfection is 100%
 The chronicity rate in VHD coinfection is <10%
 The chronicity rate in VHB is 50-70%
 The chronicity rate in VHC is 50-70%
4. Note the correct answers regarding viral hepatitis
 For VHA is usual to be fulminant
 Serologic testing IgM anti-HAV is required to confirm a diagnosis of acute HAV infection
 HAV RNA can be detected in the blood and stool of the majority of persons during the acute
phase
 Symptomatic HEV infection is most common in young adults aged 15-40 years
 In general, viral hepatitis E lead to chronic form in 5-7% of cases
5. Note the correct answers regarding viral hepatitis
 Hepatitis E is more severe among pregnant women, especially in third trimester
 The cause of death in pregnant women in VHE are acute hepatic failure, haemorrhage, acute renal
failure
 Hepatitis E virus causes acute sporadic and epidemic viral hepatitis
 Hepatitis C should be suspected in outbreaks of waterborne hepatitis
 Acute hepatitis B is characterized by the simultaneous presence of HBsAg and anti-HBc IgG
6. Note the correct answers regarding viral hepatitis
 Fulminate viral hepatitis A occurs frequently in pregnancy
 Most outbreaks of VHD in developing countries have been associated with contaminated
drinking water
 After resolution, both total anti-HBc antibodies and anti-HBs antibodies are present
 There is no chronic (long-term) infection in VHC
 In chronic HBV carriers, total anti-HBc antibodies are present, whereas anti-HBs antibodies are
absent
7. Note the correct answers regarding viral hepatitis
 HCV does not integrate into host DNA like hepatitis B virus
 Hepatitis A virus causes acute sporadic and epidemic viral hepatitis
 In general, VHD-coinfection is a self-limiting viral infection followed by recovery
 Occasionally (very rarely) a fulminant form of VHA develops
 Hepatitis C should be suspected in outbreaks of waterborne hepatitis
8. Note the correct answers regarding viral hepatitis
 The nucleotide sequence of HCV is highly variable, that accounts for resistance to antibodies
 VHB contains a single-stranded genome of RNA
 The pathogenesis of liver damage in VHC is due to a combination of direct cytopathic and of
immune mediated mechanisms
 In VHC infections are often inapparent or subclinical
 Chronic infection does not occur in VHD
9. Note the correct answers regarding viral hepatitis
 HBV is an extremely resistant strain capable of withstanding extreme temperatures and humidity
 Appears that VHB-virus is not direct cytotoxic
 HBV-DNA in hepatocyte may exist as an integrated (double-stranded, intranuclear) form or as an
episomal (free) form.
 The HBV carrier rate variation is 50-70% worldwide
 Hepatocellular carcinoma is frequent in VHE hepatitis
10. Note the correct answers regarding viral hepatitis
 Serum transaminases are elevated even before jaundice appear
 HBsAg may be detected in incubation period
 For VHE is characteristic the extrahepatic manifestations like arthritis or membranous
glomerulonephritis
 IgM anti-HBc appears late in the disease
 HBsAg is borne by surface viral proteins
11. Note the correct answers regarding viral hepatitis
 The prejaundice manifestation in VHA includes dyspeptic syndrome, arthralgic syndrome
 HBeAg (E antigen) indicates HBV replication
 HBsAb (antibody to surface antigen) indicates long term immunity
 Pegylated interferon is used for the treatment of VHA and VHE hepatitis
 The vaccines presently used for VHB immunization are composed of HBsAg
12. Note the correct answers regarding viral hepatitis
 HBeAg (E antigen) correlates with high infectivity
 Pegylated interferon is used for the treatment of VHC, VHB and VHD hepatitis
 All newborns must be vaccinated for VHE
 VHD consists of an RNA genome
 The transmission of the Delta agent mirrors that of HEV
13. Note the wrong answer regarding viral hepatitis
 All newborns must be vaccinated for VHB
 The transmission of the Delta agent mirrors that of HBV
 HDV has a direct cytopathic effect
 HBsAb (antibody to surface antigen) may indicate chronic carrier status
 The clinical expression of acute hepatitis D may range from mild to severe, fulminant hepatitis
14. Note the correct answers regarding viral hepatitis
 HBeAg (E antigen) can be present in acute or chronic infection
 HBsAg (surface antigen) may indicate chronic carrier status
 IgM anti-HAV can persists for 6 months
 VHE has a significant risk factors for carcinogenesis
 HBV has a direct cytopathic effect
15. Note the wrong answer regarding viral hepatitis
 Patients with cirrhosis must be checked every 3-6 months with alpha-fetoprotein measurements
 HDV can be acquired either as a co-infection or as a superinfection
 Hepatitis D does not increase the incidence of hepatocellular carcinoma over hepatitis B infection
 Fulminant hepatic failure results from fibrotic change
 Delta infection of a previously healthy carrier of VHB may induce an acute hepatitic picture
16. Note the wrong answer regarding viral hepatitis
 Primary Delta infection in a HBsAg carrier is often severe
 Hepatitis D does not increase the incidence of extrahepatic disease over hepatitis B infection
 In fulminant hepatic failure the patient has an acute onset of severe mental changes
 100% of superinfected with HDV carriers of HBV develop chronic infection
 Hepatitis C should be suspected in outbreaks of waterborne hepatitis occurring in developing
countries
17. Note the wrong answer regarding viral hepatitis
 VHA in children is mostly asymptomatic or causes a very mild illness
 Typical signs and symptoms of hepatitis include jaundice, anorexia, an enlarged, tender liver
 VHA is more severe in pregnant women and cause death in 20% of cases
 IgG anti-HAV can remains detectable for the person's lifetime
 IgM anti-HEV appers early in the course of infection
18. Note the wrong answer regarding viral hepatitis
 Symptomatic HAV infection is most common in young adults aged 15-40 years in endemic areas
 HAV RNA can be detected in the blood and stool of the majority of persons during the acute
phase of infection
 Serologic testing to IgM anti-HBc is required to confirm a diagnosis of acute HBV infection
 The usual clinical presentation of VHA is fever, malaise, anorexia, nausea, abdominal discomfort
and jaundice
 In VHA jaundice occurs in only a small proportion of young children, but a majority of adults
1. Name the correct answer regarding types of fever:
 In continuous fever temperature remains above normal throughout the day and does not fluctuate
more than 1 °C in 24 hours

In remittent fever temperature remains above normal throughout the day and fluctuates more than
1 °C in 24 hours
 Intermittent fever is the fever with regular shift of normal and high temperature with deviations of
3- 4C
 Recurrent fever is the fever with regular shift of high temperature, lasting for 2-4 hours, and
normal temperature lasting also for 2-4 hours
 Undulant fever is a long lasting fever with irregular temperature deviations
2. Name the correct answer regarding infectious definitions:
 Communicable disease is an infectious disease that does not spreads from person to person.
 Infectious disease is damage or alteration of host cells resulting from an infection
 Infection is the ability of a microorganism to invade a suitable host, evade host defenses, to
multiply and colonize host tissues.
 Latent infection is an infection that is inactive though continuing to infect, and which remains
capable of producing symptoms.
 Systemic infection is an infection that is limited to a small area of the body
3. Name the wrong answer regarding infectious definitions:
 Symptomatic infection is an infection by a microorganism which results in some sort of
expression of lack of health (i.e., disease).
 Asymptomatic infection is colonization of the body by a microorganism that does not cause
symptoms.
 Opportunistic infection is an infection by a microorganism that normally does not cause disease
but becomes pathogenic when the body's immune system is impaired.
 Contagious disease an infectious disease that very slow and seldom spreads from person to
person
 Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare
service unit, but secondary to the patient's original condition
4. Name the correct answer regarding desensitize fractional method
 Frirst is introduced in forearm 0.1 ml of diluted 1:100 heterogenous serum
 If the diameter of edema or rash is <10 cm - the reaction is considered negative.
 In case of negative reaction is introduce subcutaneous 0.1 ml of undiluted heterogenous serum
then - all therapeutic dose
 Appreciate cutaneous reaction in 10 minutes.
 All the serum doses (diluted or undiluted) are introduced simultaneously with intravenous
injection of 60-90 mg prednysoloni
5. . Name the correct answer regarding laboratory method of diagnosis:
 Direct microscopic examination obtaining a pure culture of a microorganism
 Viruses are cultured in specialized media that does not containing living cells.
 Immunologic techniques utilize binding reactions between microbial antigens and their specific
antibodies to infer the presence of infection in a host
 Polymerase chain reaction (PCR) is a highly specific gene amplification technologies
 Selective media is such a media which inhibits non-pathogenic "normal flora", but permits
pathogenic bacteria to grow.
1. Name the correct answer regarding Leptospirosis
 Is caused by a sporochaete bacterium
 Disease is known to be spread from person to person
 Primary hosts are rats, mice and moles
 Leptospirosis is transmitted by the urine of an infected animal
 Most patients with leptospirosis do not recover
2. Name the correct answer regarding Leptospirosis
 Almost 90% of patients have icteric leptospirosis.
 Icteric Leptospirosis (Weil’s syndrome) is the mild form of the disease
 Occupations at risk include veterinarians, slaughterhouse workers, farmers
 One of the way of transmission is the contact of abraded skin with water, contaminated with urine
of infected animals
 Leptospirosis may follow a biphasic course
3. Name the correct answer regarding icteric Leptospirosis
 Leptospirosis is characterized by multissystemic manifestations
 Hepatic encephalopathy or death due to hepatic failure is frequent
 Vascular and renal dysfunction accompanied by jaundice can develop 4-9 days after onset of
disease
 Hepatomegaly & tenderness in right hypochondrium are usually detected
 ALAT is markedly elevated 20xnormal
4. Name the correct answer regarding Leptospirosis
 Renal involvement is almost invariably present in leptospirosis
 The fever in leptospirosis can lasts for 4-6 weeks
 Calf, abdominal & lumbosacral muscles pain is characteristic for leptospirosis
 There is usually no renal dysfunction in leptospirosis
 For leptospirosis is characteristic a nonspecific flulike illness of varying severity
5. Name the wrong answer regarding Leptospirosis
 High level of Creatinine Phosphokinase (CPK) is suggestive of severe leptospirosis
 There is reddish colouration of conjunctiva in leptospirosis
 There is no fever in leptospirosis
 For severe leptospirosis is characteristic nausea, vomiting, abdominal pain and multissystemic
manifestations
 For severe leptospirosis is characteristic abrupt nature of the onset
6. Name the wrong answer regarding icteric Leptospirosis
 Hepatomegaly & tenderness in right hypochondrium are usually detected
 ALAT & ASAT are either normal or mildly elevated
 The antibody response is detectable from the first days of the disease
 Renal involvement is almost invariably present in leptospirosis
 Patients may have spontaneous superficial bleeding or GIT bleeding
7. Name the correct answer regarding Leptospirosis
 Leukocytes, erythrocytes, hyaline casts, and granular casts may be present in the urinary sediment
 Azotemia and renal failure are prominent characteristics of Weil disease
 Low leukocyte count may be present.
 Patients may exhibit mild thrombocytopenia, which often is accompanied by renal failure.
 Proteinuria is never detected in leptospirosis
8. Name the correct answer regarding Leptospirosis
 Antimicrobial therapy is not indicated
 Patients with renal failure do not require dialysis
 Those with Weil syndrome may need transfusions of whole blood and/or platelets
 Marked leukocytosis may be present
 The cause of death due to leptospirosis can be pulmonary alveolar haemorrhage
1. Note the correct answer regarding Lyme disease:
 Is caused by the spirochete B burgdorferi
 Is transmitted by Ixodid species of tick
 Is transmitted by aerosols
 The local spread leads to erythema migrans
 Occurs only in Europe
2. Note the correct answer regarding Lyme disease:
 Erythema migrans does not expand
 The rash persist for 2-3 month
 Erythema migrans often occurs at the site of the tick bite
 Erythema migrans may be asymptomatic
 In the early disease tender adenopathy may be noted
3. Note the correct answer regarding Lyme disease:
 Bronhopneumonia is often diagnosed in early stage
 During early disease patients may complain of fever, chills, myalgias, arthralgias, headache, and
malaise.
 Aseptic meningitis may develop in early disseminated stage
 The most common cardiac abnormality is atrioventricular block.
 Arthritis is the hallmark of early stage
4. Note the correct answer regarding Lyme disease:
 Diagnosis can be made clinically in the early stages of disease by the presence of erythema
migrans rash
 Patients may develop toxic shock syndrome
 Antibodies are known to persist for many years despite eradication of the infection.
 Serology is the standard of diagnosis in later stages of the disease
 Gram stain of blood reveals many gram-negative diplococcal
5. Note the correct answer regarding Lyme disease:
 Arthritis in late disease tends to involve small joints.
 Erythema migrans typically expands over days and is not evanescent
 All patients presenting with late disease have a history of erythema migrans
 Treatment successes with Lyme arthritis have been variable.
 Doxycycline, Amoxicillin, Cefuroxime, Penicillin are recomended for the treatment of Lyme
disease
6. Note the wrong answer regarding Lyme disease:
 The prognosis of Lyme disease is good with appropriate antibiotic treatment
 Encephalitis is frequent in early disseminated disease
 Some individuals with arthritis may have persistent symptoms beyond the clearance of the
infection
 Antibodies induced by the infection are not protective against further exposures
 Late disease occur weeks to months after inoculation
7. Note the wrong answer regarding Lyme disease:
 .
 Not all patients with Lyme disease recall a tick bite.
 Culturing B burgdorferi is practical and often used
 Persistent of the symptoms after adequate antimicrobial treatment suggest an autoimmune
component to chronic symptoms
 B burgdorferi may invade the blood stream, leading to disseminated disease
 Lyme disease is passed to humans mostly by the nymphs of Ixodid ticks that are more difficult to
detect because of their smaller size
1. Name the correct answer regarding infectious mononucleosis
 EBV infects human B lymphocytes
 EBV is transmitted via intimate contact with body secretions, primarily oropharyngeal secretions
 EBV is ubiquitous
 It is estimated that no more than 10% of adult demonstrate serologic evidence of a prior infection
with EBV
 Most cases of infectious mononucleosis are due to CMV
2. Name the correct answer regarding infectious mononucleosis
 Most patients with EBV infectious mononucleosis are asymptomatic
 Unilateral posterior cervical adenopathy is most highly suggestive of EBV infectious
 Exudative pharyngitis in EBV mononucleosis is commonly confused with group A streptococcal
pharyngitis
 Mortality rate in EBV infectious mononucleosis is high.
 Most patients with EBV infectious mononucleosis have leucocitosis & lymphocytosis
3. Name the classic triad of EBV infectious mononucleosis
 Fever
 glomerular nephritis
 Lymphadenopathy
 Pharyngitis
 Myocarditis
4. Name the wrong answer regarding infectious mononucleosis
 An early, transient, mild increase in serum transaminases is characteristic
 The incidence of jaundice is higher than 80%
 Severe abdominal pain is uncommon in patients with IM
 The pharyngitis may be exudative or nonexudative
 Virtually all patients report fatigue and prolonged malaise
5. Name the wrong answer regarding infectious mononucleosis
 Bilateral posterior cervical adenopathy is most highly suggestive of EBV mononucleosis
Exudative pharyngitis may present with a pseudomembrane resembling Corynebacterium
diphtheriae
 Vomiting and diarrhea are a frequent symptoms
 A macular erythematous rash may occur in IM patients who are treated with ampicillin
 High elevation of the serum transaminases should suggest other viral or drug-induced hepatitis.
 The primary mortality, which is infrequent, usually is entirely related to spontaneous splenic
rupture
6. Name the wrong answer regarding infectious mononucleosis
 Patients should avoid vigorous activity for 3 to 4 weeks to allow splenomegaly to resolve and
avoid the risk of splenic rupture
 Aspirin should be avoided, since it has been associated with rare cases of Reye's syndrome in
acute EBV
 Acyclovir show significantly improve outcomes
 Corticosteroids is indicated for severe cases and complications of EBV infection
 EBV is a member of the Herpesvirus family
7. Name the correct answer regarding infectious mononucleosis
 Most patients with EBV infectious mononucleosis have a low WBC count
 Lymphocytosis (>60%) plus atypical lymphocytosis (>10%) are the characteristic findings of
EBV infectious mononucleosis
 EBV infection induces specific antibodies to EBV and a variety of unrelated non-EBV
heterophile antibodies
 The treatment of uncomplicated EBV-IM is supportive
 Ampicillin can be used for exudative pharyngitis
8. Name the wrong answer regarding infectious mononucleosis
 Testing for EBV-specific antibodies in ELISA rapid diagnostic tests
 The heterophile antibodies react to antigens from animal RBCs.
 Most cases of EBV infectious mononucleosis are subclinical
 Generalized adenopathy is most highly suggestive of EBV infectious mononucleosis
 Although primarily a disease of young adults, EBV infectious mononucleosis may occur from
childhood to old age.
1. Note the wrong answer regarding Plague transmission:
 Rats are the most important reservoirs for the plague bacillus
 The most important vector for transmission of plague is the rat flea
 Humans are accidental hosts in the natural cycle of this disease
 The classic mode of transmission to humans is a tick bite
 Ticks and human lice have been identified as possible vectors.
2. Note the correct answer regarding pneumonic plague:
 Secondary pneumonia results from hematogenous spread
 Primary pneumonic plague is transmitted by aerosol droplets from animals or other humans.
 Patients have an gradual onset during 3-5 days
 Plague spreads rapidly in the lungs and causes acute pulmonary insufficiency, sepsis, and toxemic
shock
 Pneumonic plague is low contagious.
3. Note the wrong answer regarding plague pathogenesis:
 The lesions seen in plague are the result of the effects of plague endotoxins
 Disseminated intravascular coagulation is often the fatal complication
 Plague is now an often infection of mankind
 Although the plague bacilli are actively phagocytized by macrophages, they are not killed
 The pathology of plague is characterized by lymphangitis, lymphadenitis and bacteremia
4. Note the correct answer regarding bubonic plague:
 Patients rarely present with bubonic form of plague
 Patients have a sudden onset of high fever 40°C, chills, and headache

Patients also experience body aches, extreme exhaustion, weakness, abdominal pain, and/or
diarrhea.
 Buboes are always bilateral
 Buboes are extremely tender lymph nodes and can vary from 2-10 cm in size.
5. Note the correct answer regarding clinical manifestation in plague:
 Plague spreads rapidly in the lungs and causes acute pulmonary insufficiency
 Primary plague meningitis occurred often
 Hemorrhages occur in many parts of the body in septicemic plage
 The radiological findings in pneumonic plague, either primary or secondary, are nonspecific
 Buboes are unilateral, oval, slightly tender
6. Note the correct answer regarding plague:
 Leucocytosis with a predominance of neutrophils is observed in plage
 Serological testing can not demonstrate plague antibodies
 Thrombocytopenia is common
 Serum transaminase and bilirubin levels may be elevated
 Culture results are often negative for Y pestis
7. Note the correct answer regarding plague:
 All patients thought to have plague and signs of pneumonia are placed in strict respiratory
isolation
 Vaccination is used often
 All fluid specimens must be handled with gloves and mask to prevent aerosolization of the
infected fluids.
 Prophylactic antibiotic therapy is not recommended for persons who have had close exposure to
pneumonic plague
 Streptomycin is the preferred drug of choice to treat plague
8. Note the correct answer regarding plague:
 Patients with pneumonic plague may not be isolated
 In pneumonic plague patients have chest pain, dyspnea, productive purulent sputum, or
hemoptysis
 Septicemic plague is associated with low mortality rate
 Femoral lymph nodes are most commonly involved in bubonic plague
 Patients with plague may complain of delirium, stupor, ataxia, and speech disorders due to the
effects of endotoxin on the brain
1. Name the correct answer regarding rabia:
 Rabia is transmitted by a bite that implants saliva containing an infective dose of virus in muscle and
near nerve tissue
 Rabia can appear from burns, surgical wounds, compound fractures, or septic abortion usually is not
severe
 The virus travels along the nerves from the point of inoculation to the CNS
 Humans and animals exhibit characteristic cytoplasmic inclusion bodies in neurons of the brain,
called Negri bodies.
 All patients have local complaints related to the site of entry
2. Name the correct answer regarding rabia:
 The presence of Negri bodies is pathognomonic of rabies infection
 The mortality rate in clinical manifested rabia is 80-90%
 The incubation period is usually 30-90 days (from10 till 240 days) after exposure
 Localized rabia never progress to generalized frorm
 The onset of clinical rabies includes 2-4 days of prodromal manifestations
3. Of what dose not depend the length of this incubation period:
 The number of sensory nerves ending in the bitten area
 The dose of virus
 The severity of the bite wounds
 The distance from the bite wound from the CNS
 The clinical manifestation in the animals
4. Name the correct answer regarding prodromal period in rabia:
 Is characterized by the appearance of the ophtalmoplegia syndrome
 Low fever, malaise, headache, anorexia, nausea and sore throat
 Increasing nervousness, anxiety, irritability and depression
 Hyperesthesia, an increased sensitivity to bright light and loud noise, excessive salivation
 Compulsory presence of the complaints related to the site of entry
5. Name the wrong answer regarding rabia:
 There are three clinical phases of the disease: prodromal, excitation, paralytic
 Excitation phase begins gradually and may persist to death
 The tone of the somatic musculature is increased in excitation phase
 10-15% of patients recover from clinical manifested rabies
 Hydrophobia, the classical diagnostic manifestation of rabies
6. Name the wrong answer regarding rabia:
 For all patients not previously vaccinated is recommended postexposure rabies prophylaxis
 The wound must not be clean
 Check tetanus status and update immunization and antibiotics as necessary
 Determine rabies immune status of the biting animal
 If the domestic animal is known and can be observed for 10 days, prophylaxis can be postponed
7. Name the correct answer regarding rabia:
 If prophylaxis is warranted, do not postpone or discontinue treatment because of mild adverse
effects
 The 5-dose schedule is as follows: day 0, day 3, day 7, day 14, and day 28 postexposure.
 A progressive, general, flaccid paralysis can develop in the end stage of rabia
 Under aerobic conditions the spores of Rabia germinate and produce toxins
 Most cases of rabia are subclinical
1. Name the correct answer regarding tetanus:
 Tetanus is an infectious disorder characterized by increased muscle tone and spasms
 Tetanus is characterized by the appearance of the miastenia syndrome
 C tetani is a mobile, spore-forming, anaerobic, gram-positive bacillus
 The spores need tissue with the proper anaerobic conditions to germinate
 All patients have local complaints related to the site of entry
2. Name the wrong answer regarding tetanus:
 The spores may survive for years in some environments and are resistant to disinfectants
 Under aerobic conditions the spores of C tetani germinate and produce toxins
 Tetanus develop where there is trauma with devitalised tissue necrosis, or there are foreign bodies
in the wound
 The toxin blocks the release of the inhibitory neurotransmitters
 The toxin binding may be irreversible; recovery depends on the sprouting of new axonal
terminals
3. Name the correct answer regarding tetanus:
 The incubation period is 2-30 days, depending on the distance of the site of injury from the CNS.
 Classical triad is: trismus, risus sardonicus, dysphagia
 Waves of opisthotonus are highly characteristic of the disease
 Tetanus from burns, surgical wounds, compound fractures, or septic abortion usually is not severe
 Tetanus is characterized by the appearance of the ophtalmoplegia syndrome
4. Name the correct answer regarding tetanus:
 Noise or tactile stimuli may precipitate spasms and generalized convulsions
 If spasms occur rapidly, the prognosis is better
 Late in the disease the autonomic nervous system is involved
 In most cases, the patient lose consciousness
 Cephalic tetanus generally follows head injury or occurs with infection of the middle ear
5. Name the wrong clinical form in tetanus:
 Generalized tetanus
 Tetanus neonatorum
 Cephalic tetanus
 Respiratory tetanus
 Localized tetanus
6. Name the correct answer regarding tetanus:
 Localized tetanus involves the extremity with a contaminated wound


The mortality rate in tetanus neonatorum is low
Symptoms in cephalic tetanus consist of isolated or combined dysfunction of the cranial motor
nerves
 The newborn usually exhibits irritability, poor feeding, rigidity, facial grimacing, and severe
spasms with touch
 The condition of tetanus resolved immediately with antitoxin therapy
7. Name the correct answer regarding tetanus:
 Complications include spasm of the respiratory muscles that cause interference with breathing
 The diagnosis of tetanus is based entirely on tetanus culture
 Complications include fractures of the spine or long bones
 The patient must not be sedated
 Complications include hypertension, abnormal heartbeats
8. Name the correct answer regarding tetanus:
 Serum muscle enzyme levels (eg, creatine kinase, aldolase) may be elevated.
 The patient should be placed in a quiet room in an intensive care
 Antimicrobials are used to decrease the number of vegetative forms in the wound
 Localized tetanus never progress to generalized tetanus
 The patients abdomen is not tender in generalized tetanus
9. Name the wrong clinical manifestations of the autonomic nervous system involvement in tetanus:
 Hypothermia
 Urinary retention
 Oscillation of the blood pressure
 Severe arrhythmias
 Laryngeal spasm
10. Name the correct answer regarding tetanus:
 In tetanus the leukocyte count may be high
 The toxin binding is reversible
 Clinical tetanus always induce immunity against future attacks
 The diagnosis of tetanus is based entirely on clinical findings
 Wounds should be explored, carefully cleansed, and properly debrided.
11. Name the correct answer regarding tetanus:
 Tetanospasmin is released in the wound
 All patients should be fully immunized with tetanus toxoid during the convalescent period
 Human tetanus immunoglobulin (TIG) or equine tetanus antitoxin is recommended for treatment
 Persistent spasm of the abdominal musculature may cause opisthotonus
 A generally symmetric descending flaccid paralysis is characteristic for tetanus
1. Name the correct answer regarding tularemia:
 F tularensis is an extremely virulent organism.
 Rabbits, rodents, and ticks are the most well-known sources for transmission
 F. tularensis is an intracellular, aerobic, gram-negative coccobaccillus
 The most important vector for transmission is the rat flea
 Person-to-person transmission is characteristic
2. Name the correct answer regarding tularemia:
 Humans are accidental hosts in the natural cycle of this disease
 The primary mode of transmission is contact with infected animals or their carcasses
 After inoculation, F tularensis is ingested by and multiplies within macrophages
 The mortality rate of untreated tularemia is 100%
 Transmission can not follow the bite of a tick or deerfly
3. Name the clinical forms that can be established in tularemia:
 Glandular and ulceroglandular
 Genitourinary
 Pneumonic
 Oropharyngeal
 Osteoarticular
4. Name the wrong answer regarding tularemia:
 Common to all forms of tularemia are abrupt onset of fever, chills, headache, myalgias


Transmission can follow consumption of inadequately cooked game meats
The organism can enters through the conjunctiva from rubbing the eyes after contact with
infectious materials
 Tender lymphadenopathy occurs without evidence of local cutaneous lesions
 Buboes are always bilateral
5. Name the wrong answer regarding ulceroglandular form of tularemia:
 Ulcers are tender with raised edges and a jagged floor
 Ulceroglandular form is a rarely manifestation of tularemia
 Regional lymph nodes may become fluctuant, ulcerate and drain spontaneously
 Lymphadenopathy occur with tender suppurative local enlargement reflecting site of entry.
 Patients complain of abrupt onset of fever, chills, headache, myalgias
6. Name the correct answer regarding tularemia:
 Primary pneumonic form occurs when the organism is ingested
 In general, tularemia have a very rapid progression of illness and a high case-fatality rate
 In oculoglandular form unilateral conjunctivitis often with purulent exudates appear
 For oculoglandular form is characteristic painful preauricular / cervical lymphadenopathy
 Oropharyngeal tularemia presents as acute pharyngitis with ulcer or as ulcerative gastrointestinal
lesions with abdominal pain
7. Name the correct answer regarding tularemia:
 Blood cultures have a very high sensitivity
 The antibiotics of choices are Streptomycin, Gentamicin, Doxycycline, Ciprofloxacin
 Typhoidal (septicemic) form results in symptoms similar to those of typhoid fever
 Oropharyngeal form or gastrointestinal tularaemia is observed mostly in laboratory workers
 In ulceroglandular form occurs small erythematous papule that enlarges and ulcerates 2-3 days
later.
1. Note the correct answer regarding typhoid fever:
 Typhoid fever is a systemic infection with the bacterium Salmonella
 S typhi is a gram-negative bacillus
 Typhoid is usually contracted percutaneous way of transmission
 Today most of the burden of the disease occurs in the developed countries
 The most common sites of infection are liver, spleen, bone marrow, Peyer's patches of the
terminal ileum
2. Note the correct answer regarding typhoid fever:
 Typhoid induces immune responses that confer incomplete protection against relapse and
reinfection
 The duration of illness in an untreated individual is usually 2 months
 For typhoid fever is not characteristic long-term carriers
 In the first week the clinical features are nonspecific, with headache, malaise, and remittent fever
 Death may occur from toxemia, myocarditis, intestinal hemorrhage, or perforation
3. Note the wrong answer regarding clinical manifestation in typhoid fever:
 Constipation and mild nonproductive cough are common
 Beginning the eight day of the disease maculopapules – roseola develop on the upper abdomen
 Rose spots are caused by bacterial embolization, culture results of skin snips of the spots may be
positive
 A coated tongue, distended abdomen, hepatomegaly, and splenomegaly are common.
 Low grade is common for the typhoid fever
4. Note the correct answer regarding typhoid fever:
 Gastrointestinal bleeding occur in 70-80% of patients
 Relative bradycardia and a dicrotic pulse are common
 Distended abdomen, hepatosplenomegaly are common.
 The relapse is usually more severe than the original attack
 The patient also can complain of liquid, foul, green-yellow diarrhea
5. Note the correct answer regarding typhoid fever:
 Bleeding is clinically significant and can be rapidly fatal if a large vessel is involved
 Most chronic carriers are symptomatic
 Microscopic examination of the stool is the standard diagnostic method for the detection of
carriers
 Intestinal (usually ileal) perforation is one of the most serious complication
 A reduced level of consciousness, often accompanied by shock, is associated with high mortality
6. Note the correct answer regarding typhoid fever:
 Salmonella endotoxin block the neurotransmitter release at the nerve terminal
 A generally symmetric descending flaccid paralysis is commun
 Blood cultures are the standard diagnostic method
 For the detection of carriers, several samples should be examined because of the irregular nature
of shedding
 The sensitivity of blood culture is higher in the first week of the illness, is reduced by prior use of
antibiotics
7. Note the correct answer regarding typhoid fever:
 Typhoid is usually contracted by ingestion of food or water contaminated by fecal or urinary
carriers
 The Peyer patches become inflamed and may lead to necrosis
 During the second week of illness, the patient has a toxic appearance
 Equine antitoxin frequently is used in typhoid fever
 Orchitis and epididymitis are characteristic
8. Note the wrong answer regarding the classic pathologic stages occur in the intestines in the typhoid
fever:
 hyperplastic changes
 necrosis of the intestinal mucosa
 sloughing of the mucosa, and the development of ulcers
 epithelization
 scar formation
9. Note the wrong answer regarding typhoid fever:
 In areas of endemic disease, a fever without evident cause that lasts more than one week should be
considered typhoid
 Chloramphenicol, amoxicillin, and TMP-SMX remain appropriate for the treatment of typhoid
fever
 Severe typhoid characterized by delirium, obtundation, stupor, coma, or shock benefit from the
prompt administration of dexamethasone.
 Typhoid fever carriers can be treated with the prolonged courses of antibiotics
 All long-term carriers have a history of clinical manifested typhoid fever.
10. Note the correct answer regarding typhoid fever:
 Cirrhosis is a frequent manifestation
 Osteoarticular and genitourinary involvement are most common complications
 The relapse is usually milder than the original attack
 Intestinal perforation may be manifested by an acute abdomen
 Patients can be severely agitated, delirious, or obtunded, but complete stupor or coma is
infrequent.
11. Note the wrong answer regarding typhoid fever:
 Relapse occurs usually two to three weeks after the resolution of fever
 Gastrointestinal bleeding results from erosion of a necrotic Peyer's patch through the wall of an
enteric vessel
 In patients surviving into the fourth week intestinal complications may still occur
 It is unusual for a patient hospitalized with typhoid to have no abdominal symptoms and normal
bowel movements
 Case fatality rates of 70-80% have been reported from endemic countries
12. Note the correct answer regarding typhoid fever:
 Preexisting gallbladder disease predisposes to chronic biliary infection, leading to long-term fecal
carriage
 Transmission occurs through direct contact with animals, their carcasses or excreta, or byproducts of abortion
 Pain in the spine is an early and constant symptom, either in the neck or over the lumbar area
 Salmonella organisms are able to survive and multiply within the mononuclear phagocytic cells
 Perforation may be manifested by simple worsening of abdominal pain, rising pulse, and falling
blood pressure in an already sick patient.