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Version one questions: On flow cytometric analysis of a sample of fetal thymus, certain population of cells is identified that is positive for both CD4 and CD8 cell surface antigens. These cells are best characterized as which of the following cells? Mature helper T lymphocytes Rotavirus and Norwalk virus are distinctly different viruses. However, they share which one of the following characteristics? (A) Fecal–oral mode of transmission. (B) They mainly cause disease in infants and young children. (C) They induce generally mild disease in young children. (D) Infection patterns show no seasonal variation. (E) A double-stranded RNA genome A 32-year-old woman with AIDS is admitted with new-onset seizures. The CT scan of the head reveals multiple ring-enhancing lesions of the brain most likely caused by Toxoplasma Gondi. What CD4 T Cell count does this patient most likely have? CD4 < 100 A 23-year-old immigrant gives birth to a term newborn at home. The infant’s father cuts the umbilical cord with a kitchen knife. One week later, the infant develops rigidity and spasms. This child’s condition could most likely have been prevented by which of the following? (Immune) A. B. C. D. Infant vaccination at the time of birth Maternal vaccination during pregnancy Multivitamins during pregnancy Peripartum antibiotics to the mother E. Proper infant nutrition after birth 8. Which of the following viruses causes a mononucleosis-like syndrome and is excreted in the urine? (A) Cytomegalovirus (B) Epstein-Barr virus (C) Human herpesvirus 6 (D) Varicella-zoster virus Bone marrow transplantation in immunocompromised patients presents which major problem? (Immune) A. B. C. D. Potentially lethal graft-versus-host disease High risk of T-cell leukemia Inability to use a live donor Delayed hypersensitivity A 35-year-old African American female is being evaluated for exertional dyspnea and dry cough. She has a hi stow of intravenous dug use and multiple sexual partners. Chest x-ray shows bilateral hilar adenopathy and pulmonary infiltrates. Serum angiotensin converting enzyme levels and calcium levels are elevated. PPD testing is negative. Bronchoscopy is arranged to help determine the diagnosis. Which of the following cell types is most likely to predominate in this patient’s bronchoalveolar lavage fluid? (Immune) A. Eosinophils B. Neutrophils C. D. E. F. CD4+ lymphocytes CD8+ lymphocytes CD22+ lymphocytes Mast cells A 4-year-old Caucasian boy is evaluated for difficulty walking. Past medical history includes frequent respiratory infections. Cultured cells from this patient demonstrate a high rate of radiation-induced genetic mutation. This patient is most likely to experience which of the following? (Immune) A. B. C. D. E. F. Neurofibrillary tangles in neocortex Cerebellar atrophy Loss of neurons in the substantia nigra Atrophy of caudate nucleus Posterior column degeneration Presence of Lewy bodies anal itching. A 4-year-old girl is brought to the physician’s office by her mother because of 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. B. C. D. Ascaris lumbricoides Enterobius vermicularis Dracunculus medinensis Onchocerca volvulus Which of the following is the correct interpretation of HBV serologic markers’ dynamics shown in the graph below? (C. Micro) A. B. C. D. E. The patient had Acute Hepatitis B that progressed to chronic Hepatitis with high infectivity The patient has an exacerbation of chronic Hepatitis B The patient successfully recovered The patient was vaccinated against HBV previously The patient had Acute Hepatitis B that progressed to chronic Hepatitis with low infectivity Which of the following would be present in neonate with congenital rubella Syndrome but not in a neonate with cytomegalovirus inclusion disease? (C. Micro) A. B. C. D. Hearing loss* Pulmonary artery stenosis Mental retardation Hepatosplenomegaly An infant with microcephaly, 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. B. C. D. CMV Mumps virus RSV Rubella virus E. HIV Parvovirus infection, the cause A. B. C. D. E. of a mild exanthem in child characterized by (C. Micro) Acute hemolytic anemia Epidemic acute respiratory disease Gastroenteritis Whooping cough-like disease Keratoconjunctivitis 42-year-old male with 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. B. C. D. E. CD4 <100/ microliter CD4 <300/ microliter CD4 <400/ microliter CD4 <50/ microliter CD4 <200/ microliter All of the following is 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 F. Which of the following set of test result corresponds to the patient with chronic HBV infection and is superinfected with HDV? (C. Micro) A. B. C. D. HBsAg - , HBeAg - , ANTI-HBcAg IgM -, ANTI-HBcAg IgG -, ANTI-HBs Ag +, ANTI-HDV IgM+ HBsAg + HBeAg +, ANTI-HBc IgM+, ANTI-HBc IgG-, ANTI-HBs Ag-, ANTI-HDV IgM+ HBsAg - HBeAg -, ANTI-HBc IgM-, ANTI-HBc IgG+, ANTI-HBs Ag+, ANTI-HDV IgM+ HBsAg + HBeAg +, ANTI-HBc IgM-, ANTI-HBc IgG+, ANTI-HBs Ag-, ANTI-HDV IgM+ Each of the following statements concerning herpesvirus latency is correct except (A) Exogenous stimuli can cause reactivation of latent infection, with induction of symptomatic disease. During latency (B) , antiviral antibody is not demonstrable in the sera of infected individuals. (C) Reactivation of latent herpesviruses is more common in patients with impaired cell-mediated immunity than in immunocompetent patients. (D) Virus can be recovered from latently infected cells by cocultivation with susceptible cells. Some viruses are characterized by helical symmetry of the viruses with helical symmetry is most accurate? (A) All enveloped viruses with helical symmetry are classified into the same virus family. (B) Helical nucleocapsids are found primarily in DNA-containing viral nucleocapsid. Which of the following statements about viruses. (C) All human viruses with helical nucleocapsids possess an envelope. (D) Excess empty helical particles containing no nucleic acid are commonly produced in infected cells. Type IV hypersensitivity responses a. are mediated through antibody-antigen complexes b. typically occur immediatly dermatitis c. occur in contact d. occur in hay fever Type III hypersensitivity responses a. are mediated through antibody-antigen complexes b. typically occur in 15 minutes c. occur in contact dermatitis d. are Ig-E mediated Cytotoxic T cells induced by infection with virus A will kill target cells a. from the same host infected with any virus. b. infected by virus A and identical at class I MHC loci of the cytotoxic T cells. c. infected by virus A and identical at class II MHC loci of the cytotoxic T cells. d. infected with a different virus and identical at class I MHC loci of the cytotoxic cells You have a patient who makes autoantibodies against his own red blood cells, leading to hemolysis. Which one of the following mechanisms is MOST likely to explain the hemolysis a. Perforins from cytotoxic T cells lyse the red cells b. Neutrophils release proteases that lyse the red cells c. Interleukin-2 binds to its receptor on the red cells, which results in lysis of the red cells. d. Complement is activated, and membrane attack complexes lyse the red cells. In what manner does a type III hypersensitivity reaction differ from a type II hypersensitivity reaction? a. Type III is an immediate hypersensitivity, while type II is a delayed hypersensitivity reaction b. Type III hypersensitivities involve IgD, while type II hypersensitivities involve IgG and IgM. c. Type III hypersensitivities are B-cell mediated, while type II hypersensitivities are T-cell mediated. d. The antigens involved in a type III reaction are not bound to a cell's surface, while those involved in a type II reaction are bound to the surface Rejection of a tumor may involve which of the following? a. T-cell-mediated cytotoxicity b. ADCC c. complement-dependent cytotoxicity d. All answer are correct An antigen found in relatively high concentration in the plasma of normal fetuses and a high proportion of patients with progressive carcinoma of the colon is a. viral antigen. b. carcinoembryonic antigen. c.IgG d. bacterial Which of the following are derived from peripheral blood of a patient and cultured with recombinant IL-2? TILs Herpes simplex virus and cytomegalovirus share many features. Which one of the following features is least likely to be shared? (A) Important cause of morbidity and mortality in the newborn (B) Congenital abnormalities caused by transplacental passage (C) Important cause of serious disease in immunosuppressed individuals (D) Mild or inapparent infection Which of the following viruses causes a mononucleosis-like syndrome and is excreted in the urine? A 2-month-old infant developed a respiratory illness that the pediatrician diagnosed as bronchiolitis. The most likely cause of the disease is Multiple Choice Multiple Choice A nurse develops clinical symptoms consistent with hepatitis. She recalls sticking herself with a needle approximately 4 months before after drawing blood from a patient. Serologic tests for HBsAg, antibodies to HBsAg, and hepatitis A virus (HAV) are all negative; however, she is positive for IgM core antibody. The nurse Multiple Choice [Y]Cytomegalovirus EpsteinBarr virus (A) Parainfluenza virus type 4 Does not have hepatitis B [Y](B) Respiratory syncytial virus Has hepatitis A Human herpesvirus 6 (C) Influenza virus Is in the late stages of hepatitis B infection Varicellazoster virus Herpes simplex virus type 2 (D) (E) Measles Metapneumovirus virus [Y]Is in the “window” (after the disappearance of HBsAg and before the appearance of anti-HBsAg) Has hepatitis C Human papillomavirus can cause Multiple cancer in humans and is most Choice commonly associated with Rectal polyps Regarding the oncogenes of DNA tumor viruses, which one of the following is most accurate? They encode protein kinases that phosphorylate p53 protein. Regarding prions, which one of the following is the most accurate? Multiple Choice Multiple Choice The genome of prions consists of a negativepolarity RNA that has a defective polymerase gene. Breast cancer Prostate cancer They interact with cellular protooncogenes and activate them. [Y]Prion proteins are characterized by having changes in conformation from the alpha-helical form to the beta-pleated sheet form. [Y]Anogenital cancers They encode cellular growth factors that activate Sphase DNA synthesis. Prions are very sensitive to ultraviolet (UV) light, which is why UV light is used in hospital operating rooms to prevent their transmission. Mesotheliomas [Y]They encode proteins that bind to the proteins encoded by tumor suppressor genes. The main host defense against prions consists of an inflammatory response composed primarily of macrophages and CD4positive T cells. Which of the following statements regarding virus morphology is true? Multiple Choice What is the definition of the eclipse phase? Which one of the following is a disease in which the role of parvovirus B19 has not been established? Multiple Choice Helical nucleocapsids are found with single-stranded DNA viruses Multiple Choice Erythema infectiosum (fifth disease) All RNA viruses are spherical in shape. Some viruses with DNA genomes contain a primitive nucleus. [Y] When the virus is developi ng but not yet infectious Transient aplastic crisis When a virus mature s and is capabl e of infectin ga new host Hydrops fetalis [Y] Viral surface proteins protect the viral genome from nucleases. When the active, infectio us viral particle escapes from the host Some viruses contain flagella. When the viral DNA become s latent as a prophag e [Y] Fulminant hepatitis Whe n the virio n enter s the host cell Each of the following statements concerning herpesvirus latency is correct except Multiple Choice Herpes simplex virus and cytomegalovirus share many features. Which one of the following features is least likely to be shared? Which feature of the variola virus makes it an extreme bioterrorism threat? Multiple Choice Multiple Choice Exogenous stimuli can cause reactivation of latent infection, with induction of symptomatic disease. [Y]During latency, antiviral antibody is not demonstrable in the sera of infected individuals. Important cause of morbidity and mortality in the newborn [Y]Congenital abnormalities caused by transplacental passage Wide availability of the virus Weaponized strains present in several laboratories Reactivation of latent herpesviruses is more common in patients with impaired cellmediated immunity than in immunocompetent patients. Important cause of serious disease in immunosuppressed individuals [Y] Limited immunity in present population Virus can be recovered from latently infected cells by cocultivation with susceptible cells. Mild or inapparent infection Low stockpiles of effective drugs for treatment Potential emergence from animal reservoir Regarding viroids, which one of the following statements is the MOST accurate? Which of the following viruses is primarily transmitted by the fecaloral route? Your patient is a 27year-old man with a history of intravenous drug use who now is diagnosed with chronic hepatitis C. He is HIV antibody negative. Which one of the following is the best choice of drugs to treat his chronic hepatitis C? Cellular oncogenes represent activated genes involved in cancer. A second class of cancer Multiple Choice Multiple Choice Multiple Choice Multiple Choice They are defective viruses that are missing the DNA coding for the matrix protein. St. Louis encephalitis virus Acyclovir and foscarnet [Y] They consist of RNA without a protein or lipoprotein outer coat. Colorado tick fever virus Ganciclovir and enfuvirtide Protooncogenes They cause tumors in experimental animals. [Y] Coxsackievirus [Y] Peginterferon and ribavirin [Y] Tumor suppressor genes They require an RNA polymerase in the particle for replication to occur. Yellow fever virus Dengue fever virus Zidovudine and lamivudine Zidovudine and ritonavir Transduced genes Silent genes T antigen genes genes is involved in cancer development only when both alleles of such a gene are inactivated. The second class of genes is called Regarding Plasmodium species, which one of the following is most accurate? Multiple Choice [Y]These organisms are transmitted by the bite of female Anopheles mosquitoes. The bite of the vector injects merozoites into the bloodstream that then infect red blood cells. Both male and female gametocytes are formed in the vector and are injected into the person at the time of the bite. Hypnozoites are produced by P. falciparum and can cause relapses of malaria after the acute phase is over. Malaria caused by P. vivax is characterized by a cerebral malaria and blackwater fever more often than malaria caused by the other three species. prionmediated Regarding Multiple Choice diseases, which one of the following is the most accurate? A 70-year-old woman with no significant medical history begins to experience memory loss and personality changes. Over the next few months, her symptoms become more severe, as she experiences rapid mental deterioration. She also starts to have sudden, jerking movements in response to being startled and gait Multiple Choice [Y] Prionmediated diseases are characterized by vacuoles in the brain called “spongiform changes.” Loss of dopaminergic neurons in the substantia nigra pars compacta. Variant CreutzfeldtJakob disease is a disease of cattle caused by the ingestion of sheep brain mixed into cattle feed. Kuru is a prionmediated disease for which the diagnosis can be confirmed in the laboratory by a fourfold or greater rise in antibody titer. Autoimmune inflammation and demyelination of the central nervous system. In CreutzfeldtJakob disease, only neurons latently infected by JC virus produce the prion filaments that disrupt neuronal function. Autoimmune inflammation and demyelination of the peripheral nervous system. CreutzfeldtJakob disease occurs primarily in children under the age of 2 years because they cannot mount an adequate immune response to the prion protein. [Y] Conversion of a protein from an a- helix to a ß-pleated form, which resists degradation. disturbances. Eventually, she lapses into a coma and dies eight months after the onset of symptoms. What process likely caused this woman's illness? Plasmodium Neurosyphilis er Version 2 questions: A nurse develops clinical symptoms consistent with hepatitis. She recalls sticking herself with a needle approximately 4 months before after drawing blood from a patient. Serologic tests for HBsAg, antibodies to HBsAg, and hepatitis A virus (HAV) are all negative; however, she is positive for IgM core antibody. The nurse (Micro) A. B. C. D. E. She does not have hepatitis B She has hepatitis A She is in the late stages of hepatitis B infection She is in the "window" (after the disappearance of HBsAg and before the appearance of anti-HBsAg) She has hepatitis C Regarding hepatitis C virus (HCV) and hepatitis D virus (HDV), which one of the following is MOST accurate? (Micro) A. HCV is transmitted by blood, but HDV is not. B. More than half of HCV infections result in a chronic carrier state. C. There is an effective vaccine against HCV but not against HDV. Both HCV and HDV are defective RNA viruses and require concurrent HBV infection to replicate. The paramyxoviruses include the most important causes of respiratory infections in infants and young children. Which of the following is not characteristic of paramyxoviruses? (Micro) A. Genome is negative-sense RNA. B. C. D. E. Envelope contains a glycoprotein with fusion activity. Paramyxoviruses do not undergo genetic reassortment. Replication cycle occurs in cytoplasm of susceptible cells. Genome is segmented. A 34-year-old electric company worker presents to the urgent care clinic with a pruritic skin rash on his right arm. He relates the rash to recent plant exposure while doing a repair job for his company in a wooded area. Physical examination reveals a linear eruption with vesiculation. Which of the following cells would be found lesion? (Immune) A. B. C. D. E. F. earliest in this patient's skin Mast cells Eosinophils Neutrophils Macrophages T lymphocytes Plasma cells A 71-year-old male who suffers from chronic obstructive pulmonary disease receives yearly shots of a killed viral vaccine. When he is subsequently exposed to this virus, which of the following is thought to happen? (Immune) A. Infective dose of the virus is decreased B. Virus entry into cells is impaired C. Virus replication inside cells is impaired D. Viral progeny release from cells is impaired E. Infected cells are destroyed by sensitized T-lymphocytes A 4-year-old Caucasian male is evaluated in your clinic for recurrent skin and respiratory infections. He has light skin and silvery hair. Horizontal nystagmus is present on eye examination. Peripheral blood smear demonstrates giant cytoplasmic granules in neutrophils and monocytes. The patient most likely suffers from which of the following disorders? (Immune) A. B. C. D. Chronic granulomatous disease Phenylketonuria DiGeorge syndrome Wiskott-Aldrich syndrome E. Chédiak-Higashi syndrome F. Albinism Two months after having received an allogeneic stem cell transplant for the treatment of acute lymphoblastic leukemia, a patient presented with diarrhea and a blistering, erythematous appearance to the skin of his anterior neck and back. Serum chemistry revealed elevated liver enzymes and billirubin, and the liver and spleen appeared enlarged on physical examination. Which of the following diseases or pathogenic mechanisms is most likely causing this clinical picture? (Immune) A. B. C. D. E. Rejection of the transplant Autoantibody production against the patient’s lymphocytes Deposition of immune complexes in the skin and liver A reaction to his immunosuppressive drugs Graft-versus-host disease Which of the following statements is incorrect (Immune) A. dsDNA-anti-dsDNA complexes can initiate glomerulonephritis B. Contact dermatitis due to poison ivy is an antigen-antibody complex disease C. Macrophages are activated nonspecifically by IFN-g D. Cross-linkage by antigen of two or more IgE molecules causes degranulation of sensitized mast cells anal itching. A 4-year-old girl is brought to the physician’s office by her mother because of 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) E. F. G. H. I. Ascaris lumbricoides Enterobius vermicularis Dracunculus medinensis Onchocerca volvulus Wuchereria bancrofti A 34 year old nurse with recent onset of malaise is found to have the following set of laboratory findings: Anti HAV IgM - positive, Ant 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 Previously healthy and 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. B. C. D. E. F. Enterovirus 71 Calicivirus Echovirus 31 Parainfluenza virus** Coxackievirus A Coxsackievirus B An otherwise healthy 16 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 cause F. G. H. I. J. of a mild exanthem in child characterized by (C. Micro) Acute hemolytic anemia Epidemic acute respiratory disease Gastroenteritis Whooping cough-like disease Keratoconjunctivitis 42-year-old male with 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: F. G. H. I. J. CD4 <100/ microliter CD4 <300/ microliter CD4 <400/ microliter CD4 <50/ microliter CD4 <200/ microliter Your patient is a 75-year-old woman with fever, chills, and myalgias that began yesterday. 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? (Micro) A.Oseltamivir B. Interferon C. Amantadine D. Acyclovir Which one of the following is a disease in which the role of parvovirus B19 has not been established? = fulminant hepatitis Arboviruses are transmitted by bloodsucking arthropods from one vertebrate host to another. Arboviruses are found in the following virus families except which of the following? (A) Togaviridae (B) Flaviviridae (C) Bunyaviridae (D) Reoviridae (E) Arenaviridae Herpes simplex virus and cytomegalovirus share many features. Which one of the following features is least likely to be shared? (A) Important cause of morbidity and mortality in the newborn (B) Congenital abnormalities caused by transplacental passage (C) Important cause of serious disease in immunosuppressed individuals (D) Mild or inapparent infection The clinical picture of arbovirus infection fits one of three categories: hemorrhagic fever, or fever with myalgia. One of the characteristics of arboviruses is that? - They are closely related to parvoviruses Majority of them are RNA viruses – I think They usually cause symptomatic infection in humans They are only transmitted by mosquitos – no by more insects Frok book: The clinical picture of arbovirus infection fits one of three categories: encephalitis, hemorrhagic fever, or fever with myalgia. One of the characteristics of arboviruses is that they Are closely related to parvoviruses [Y]Are transmitted by arthropod vectors Are usually resistance to ether Usually cause symptomatic in humans All of the above A 10-year-old child develops fever and headache. Acute viral meningitis is diagnosed. What is the most likely cause of this child’s infection? - HSV-1 Rubella EBV Mumps virus Enterovirus N. Meningitis A nurse develops clinical symptoms consistent with hepatitis. She recalls sticking herself with a needle approximately 4 months before after drawing blood from a patient. Serologic tests for HBsAg, antibodies to HBsAg, and hepatitis A virus (HAV) are all negative; however, she is positive for IgM core antibody. The nurse (Micro) F. G. H. I. J. She does not have hepatitis B She has hepatitis A She is in the late stages of hepatitis B infection She is in the "window" (after the disappearance of HBsAg and before the appearance of anti-HBsAg) She has hepatitis C A 72-year-old patient comes to your office and complains of fever 38.2 C evening, athralgia and myalgia for 3 days. She also has dry cough, sore throat and rhinorrhea. Sense of smell and taste is somewhat decreased. Which of the following tests is reasonable to perform this time? - CT scan of the lungs PRP, VDRL SARS-COV-2 PCR Blood culture Lumbar puncture Risk factors for severe MERS coronavirus infection include which of the following? - Recent camel exposure Seasonal allergies Prior corona virus infection Chronic obstructive pulmonary disease Regarding Multiple Choice Plasmodium species, which one of the following is most accurate? [Y]These organisms are transmitted by the bite of female Anopheles mosquitoes. The bite of the vector injects merozoites into the bloodstream that then infect red blood cells. Both male and female gametocytes are formed in the vector and are injected into the person at the time of the bite. Hypnozoites are produced by P. falciparum and can cause relapses of malaria after the acute phase is over. Malaria caused by P. vivax is characterized by a cerebral malaria and blackwater fever more often than malaria caused by the other three species. Double Positive T Cells Express? - Both CD4 and CD8 cells Which of the following HLA subtypes are associated with insulin-dependent? - HLA-DR3 – HLA-DR-4 39-year-old otherwise healthy patient develops chills and high fever of 39.2 C. 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? H.Influenza M. Pnemonia L.pnemonia S.Pneumonia But H.Inf and M.Pnemonia could also be …. A 15-year-old girl presents 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? - Hand foot and mouth disease EBV Herpangina Primary herpes CMV esophagitis Strep throat This from book: 5. Outbreaks of hand-foot-and-mouth disease, characterized by oral ulcerations and vesicular rashes, occur and may result in infant deaths. The disease is caused by (A) Foot-and-mouth disease virus (B) Chickenpox virus (C) Nonpolio enteroviruses (D) Rhinoviruses (E) Rubella virus A 7-year-old girl is brought to the office due to diffuse rash. The father says she developed a lace-like, erythematous rash this morning on her stomach, back and extremities. Two days ago, the girl developed red, flushed cheeks. She also had congestion, headache, and a low-grade fever for 3 days earlier this week. Last week, her youngster brother had similar symptoms that resolved spontaneously. The infection agent most likely responsible for this patient’s disease replicates in progenitors of which of the following cell lines? ????????????? A 15-year old female develops fever myalgia and headache an outbreak of an illness with similar symptoms caused by a echovirus is known to be occurring in the community the primary anatomic site of echovirus multiplication in the human host is? - GI tract The blood and lymph system The muscular system The respiratory system The central nervous system From Q bank: One month after school has been let out for the summer, a 16-year-old girl develops fever, myalgia, and headache. An outbreak of an illness with similar symptoms caused by an echovirus is known to be occurring in the community. The primary anatomic echovirus multiplication in the human host is (Micro) A. B. C. D. E. The muscular system The central nervous system The alimentary tract The blood and lymph system The respiratory system site of A 45-year old man recent immigrant from Bostwana is brought to the emergency room with a cough productive of bloody sputum he first noticed a cough approximately two months ago. He reports having lost approximately 5 kg in this timeframe as well. He also notes that he's had drenching night sweats two or three nights a week for the past month. Which of the following is the most likely cause of his condition? - S. Pneumonia M.tuberculosis HIV Chronic … ? A 32-year-old sexually experienced female complained 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? - M.Pneomonia Herpes simplex virus Syphilis Acute HIV syndrome Papillomavirus C.Trachomatis (chlamydia trachomatis) – I think Risk factor for severe MERS coronavirus infection include which of the following? - Recent Camel exposure - Severe allergies Prior corona virus infection Chronic obstructive pulmonary virus Once they leave the marrow, in order to survive mature naive B cells must enter the a. circulation b. lymph microenvironment. c. primary lymphoid follicles. e. thymus. Which of the following viruses causes infectious mononucleosis and becomes latent in B-cells? - Varicellar-zoster virus EBV (Ebstin-Bar-Virus) Cytomegalovirus Human herpesvirus 6 Herpes simplex virus type 2 A 30-year old asymptomatic woman is found to have a positive VDRL ( Venereal disease research laboratory test) test she denies having had sexual contact with a partner who had symptoms of venereal disease. What is the next step? - Reassure her the test is a false-positive if she doesn’t have any symptoms Perform FTA-ABS test on a specimen of her serum Treat her with penicillin Trace her sexual contacts for serologic testing Which of the following is NOT true about TCR? - CDR3 of TCR has the most sequence variability from molecule to molecule All TCRs on a particular T Cell have identical idiotypes TCR has binding sites for both antigen and self MHC All 3 answers provided are true A 31-year-old man is admitted to the hospital due to the 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 3 cm cystic lesion in the temporal lobe. The mass is excised and histopathology is shown in the image below. Which of the is the likely diagnosis? - Helminth infection Meningioma Metastatic disease Tuberculosis Where are the M cells focused in GI tract exactly located? - They are found in every layer of GI tract wall They are not found in the gut at all Follicles as Peyer's patches Follicle associated keratinized epithelium 1. Your patient is a 75-year-old woman with fever, chills, and myalgias that began yesterday. 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? (Micro) E. Oseltamivir F. Interferon G. Amantadine H. Acyclovir You are a patient is a 30-year old woman with non-bloody diarrhoea for the past 14 hours which one of the following organisms is least likely to cause this illness? A 30-year woman has non-bloody diarrhea for the past 14 hours. Which one of the following organisms is least likely to cause this illness? a. Streptococcus pyogens b. Clostridiodes difficile c. Shigella dysenteriae d. Salmonella enteritidis - Listeria Monocytogens A 25-year old female medical student report that she had lunch at fish restaurant in the afternoon she reports eating sushi and seafood she's 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? - Clostridium Difficile E.coli (ETC) Rotavirus Clostridium botulinum food poisoning Listeria monocytogens Norovirus ??????????????????????????? Laryngeal papilloma in children can be caused by which of the following viruses? - None of the above Caliciviridae Molluscum contagiusom virus Polyomavirus JC Papillomavirus From book: Laryngeal papillomas in children are generally caused by the same viruses that cause benign genital condylomas. These viruses are - Papillomaviruses, types 6 and 11 Polyomavirus JC Epstein-Barr virus Molluscum contagiosum virus Papillomaviruses, types 16 and 18 An 11-year old boy develops sore throat headache, tearing and bilateral conjunctivitis. After medical exam he's found to have a fever of 37 Celsius degree and mild preauricular lymphadenopathy. Within the next 2 days several of his classmates develop similar symptoms which of the following is the most likely cause? - HSV-1 Parvovirus B19 Adenovirus Chlamydia S. Aureus Mumps Virus From book: 2. An otherwise healthy 11-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. B. C. D. E. Rhinovirus Adenovirus Metapneumovirus Coronavirus Influenza virus What is the function of ficolins (1-3)? - All answers are correct Agglutinin Op… - … compelemnt Which of the following clinical scenario most likely explains the following serologic markers found in the 17-year-old body: Anti-HAV IgM + AntiHAV IgG – HbsAg + HBeAg – Anti Hb … Anti-HBeAg + Anti-HCV – - Acute Hepatitis E Acute hepatitis A plus chronic HC Acute Hepatitis B plus acute HDV Acute hepatitis C Acute hepatitis A Plus Hepatitis B From book: 43-year-old nurse has a following reading of serologic markers for viral hepatitis: Antti HAV igM -Negative, Anti HAV igG – positive, HBsAG – Negative, HBeAg – Negative, Anti HBs – positive, Anti-HBc – negative, Anti-HBe – negative, Anti- HCV – negative. The patient most likely:? = has recovered from HBV recently, has been vaccinated against HBV A 9-year old boy is admitted to ER with complaints of severe pain of left leg. He is unable and refuses to walk. He has fever of 38.7 C. WBCs are elevated. Which of the following is the most likely cause of his symptoms? - N.Meningitis B. burgdorferi S. aureus Coxackivirus b M.tuberculosis Meningitis is inflammation of the tissues around the brain. ... Leg pains. The pains can become severe and prevent a child from standing or walking. ?????????????????????????/ ACE 2 is a receptor for which of the following viruses? - SARS-CoV2 HTLV 1 Herpes simplex HIV Ebstein-Bar Virus A woman was hiking in an isolated area when a skunk Multiple Choice appeared and bit her on the leg. She now presents to your emergency room about an hour after the bite. Which one of the following is the most appropriate thing to do? Which of the following viruses can be transmitted through blood? - Human T-lymphocytic virus Hepatitis D Virus Hepatitis C virus HIV All of the above [Y] Give rabies vaccine and hyperimmune globulin immediately. Test the patient’s serum for antibodies now and in 10 days to see if there is a rise in antibody titer before treating her. Reassure her that rabies is not a problem because skunks do not carry rabies. Quarantine the animal for 10 days and only treat her if signs of rabies appear in the animal. IgA as well as IgM is an antibody that can be secreted. Majority of it actually exists in a second form in GI and respiratory tracts. What is the essential factor that makes it possible to secret IgA? - IgA needs to polymerize and afterwards undergo enzymatic cleavage inside plasma cells in order to get secreted from mucosal epithelial cells G chain produced from plasma cells that converts monomeric IgA into dimeric form There is no pre-existing requirement for IgA to get secreted Poly-Ig receptor that binds to the J chain of dimeric IgA Chagas disease is especially feared in Latin America because of the damage that can occur to the heart and parasympathetic nervous system and the lack of an effective drug for the symptomatic later stages. Your patient is planning to reside in a Venezuelan village for 1–2 years. Which one of the following suggestions would be of special value for avoiding Chagas disease? (A) Boil or treat all of your drinking water. (B) Sleep under a bed net. (C) Do not keep domestic pets in your house. (D) Never walk barefoot in the village compound. (E) Do not eat lettuce or other raw vegetables or unpeeled fruit. Which of the following is not a special anatomic structure of the gastrointestinal tract? - Peyer’s patches - Keratinizing stratified squamous epithelium Lamina proper follicules Tonsils – they are part of immune system Which of the following best describes available HPV vaccines? - Live attenuated virus mRNA none of the above live recombinant virus toxoid From internet: Which of the following best describes available HPV vaccines? Select one: a. Live attenuated virus b. Live recombinant virus c. Inactivated whole virus d. Noninfectious subunit e. Toxoid Noninfectious subunit Herpes simplex virus and cytomegalovirus share many features. Which one of the following features is least likely to be shared? (A) Important cause of morbidity and mortality in the newborn (B) Congenital abnormalities caused by transplacental passage (C) Important cause of serious disease in immunosuppressed individuals (D) Mild or inapparent infection Your patient is a 25-year-old 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? [Y]L. donovani P. falciparum T. gondii T. brucei T. cruzi African Sleep Sickness Toxoplasmosis Malaria Visceral leishermiasis – I think Chaga’s disease Antibody Fc Fragments contain? Fc (50,000 daltons) fragments contain the CH2 and CH3 region and part of the hinge region held together by one or more disulfides and noncovalent interactions. Fc and Fc5µ fragments are produced from fragmentation of IgG and IgM, respectively. ?????? Which is NOT true of virions? - Are extracellular May have an envelope Contain DNA and ribosomes – they don’t have ribosomes - Contain RNA A 15-month-old is referred to a pediatric immunologist by his pediatrician for further workup of recurrent sinopulmonary infections which have not abated despite adequate treatment. During the workup flow cytometry demonstrates a decrease in normal CD40L cells. Based on these findings, the immunologist decides to pursue a further workup and obtains immunoglobulin levels. Which of the following immunoglobulin profiles is most likely to be observed in this patient? - Decreased IgE, IgM, Iga, IgG Increased IgM, Decreased IgG, IgA, IgE Increased IgE, IgA, Decreased IgM Increased IgE, Decreased IgG, IgM Regarding poliovirus, which one of the following is MOST accurate? Regarding poliovirus, which one of the following is MOST accurate? Multiple Choice Poliovirus remains latent within sensory ganglia, and reactivation occurs primarily in immunocompromised patients. [Y] When the live, attenuated virus in the oral vaccine replicates, revertant mutants can occur that can cause paralytic polio. Human papillomavirus can cause cancer in humans and is mot commonly associated with? The widespread use of the killed vaccine in the countries of North and South America has led to the virtual elimination of paralytic polio in those areas. The current recommendation is to give the live, attenuated vaccine for the first 3 immunizations to prevent the child from acting as a reservoir, followed by boosters using the killed vaccine. - Breast cancer Mesothelioma Prostate cancer Cervical cancer Rectal polyps From book: Human papillomavirus can cause Multiple cancer in humans and is most Choice commonly associated with Rectal polyps Breast cancer Prostate cancer [Y]Anogenital cancers Mesotheliomas ----Your patient is a 20-year-old woman with chronic hepatitis B that was diagnosed by detecting hepatitis B antigen in her blood more than 6 months after her acute infection. Which one of the following is the best choice of drug to treat her chronic B? hepatitis Multiple Choice Acyclovir Foscarnet [Y]Entecavir Ritonavir Zidovudine A 70-year-old woman with no significant medical history begins to experience memory loss and personality changes. Over the next few months, her symptoms become more severe, as she experiences rapid mental deterioration. She also starts to have sudden, jerking movements in response to being startled and gait disturbances. Eventually, she lapses into a coma and dies eight months after the onset of symptoms. What process likely caused this woman's illness? Multiple Choice Loss of dopaminergic neurons in the substantia nigra pars compacta. Autoimmune inflammation and demyelination of the central nervous system. Autoimmune inflammation and demyelination of the peripheral nervous system. [Y] Conversion of a protein from an a- helix to a ß-pleated form, which resists degradation. Your patient is a 30-year-old man with persistent watery diarrhea for 2 weeks. He is HIV antibody positive with a CD4 count of 10. Routine stool culture revealed no bacterial pathogen. Ova and parasite analysis revealed cysts that stained red in an acid-fast stain. Of the following, which one is the most likely cause of this infection? Multiple Choice [Y]C. hominis Your patient is a 30-year-old man with persistent watery diarrhea for 2 weeks. He is HIV antibody positive with a CD4 count of 10. Routine stool culture revealed no bacterial pathogen. Ova and parasite analysis revealed cysts that stained red in an acid-fast stain. Of the following, which one is the most likely cause of this infection? - Entamoeba – this Cryptococcus Trichomonas Giardia – or this – maybe this more E. histolytica G. lamblia T. vaginalis One month after school has been let out for the summer, a 16-year-old girl develops fever, myalgia, and headache. An outbreak of an illness with similar symptoms caused by an echovirus is known to be occurring in the community. The primary anatomic echovirus multiplication in the human host is (Micro) A. B. C. D. E. The muscular system The central nervous system The alimentary tract The blood and lymph system The respiratory system site of An 8-year old boy is brought into the office when at 3-day history of fever and mild sore throat. The rash started on his face and spread to his arm the legs on examination his temperature is 37.7 Celsius degree 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 petechiae. What is the most likely diagnoses? - Erythema nodosum Erythema marginatum Erythema induratum Erythema multiforme - Erythema infectiosum Your new patient is young female from Ireland who came to visit Georgia 4 days ago she complains of diarrhea crampy abdominal pain and nauseated stool analysis doesn't show RBC or white blood cells which of the following pathogenic bacteria is most commonly associated with this condition? - Campylobacter jejuni Salmonella Typhimurium E. coli ETEC Shigella ??? A 3-year-old Cuban-american male has a history of recurrent pseudomonas and candida infections. Laboratory analysis reveals no electrolyte abnormalities. Examination of his serum shows decreased levels of igG and CT scan reveals the absence of a thymus. The child likely has? = - severe combined immunodeficiency syndrome Regarding human papillomavirus (HPV), which one of the following is MOST accurate? - Medications can effectively cure HPV infected cells – Not curable HPV is an enveloped virus with genome composed of double-stranded RNA (Doesn’t have envelop) HPV is associated with penile cancer development - Blood and blood products are an important mode of transmission of HPV – Sexual contact