1. In hepatitis C (HCV) a chronic carriage rate is

1. 5%

2. 15%

3. 25%

4. 40%

5. >50%

2. Typical liver function values in acute hepatic failure include

1. hypoalbuminaemia

2. hyperglycaemia

3. serum alkaline phosphatase > 6 times normal

4. peripheral blood lymphocytosis

5. prolonged prothrombin time

3. The typical features of type A viral hepatitis (HAV) include

1. picornavirus infection spread by the faecal-oral route

2. an incubation period of 3 months

3. a greater risk of acute liver failure in the young than in the old

4. progression to chronic hepatitis if cholestasis is prolonged

5. left hypochondrial pain and tenderness

4. In hepatitis C (HCV)

1. the infecting agent is an RNA flavivirus

2. the disease does not progress to chronic hepatitis

3. most patients experience the symptoms of acute hepatitis

4. the virus is responsible for 40% of all post-transfusion hepatitis

5. a chronic carriage rate of > 15% is the rule

5. The typical features of hepatic cirrhosis include

1. a small shrunken liver

2. painful splenomegaly

3. haemolytic anemia

4. Kayser-Fleischer rings

5. obstructive jaundice and pruritus

6. The serum alanine aminotransferase (ALT) concentration is

1. derived from a microsomal enzyme specific to hepatocytes

2. typically more than six times normal in acute viral hepatitis

3. usually normal in both obstructive and haemolytic jaundice

4. likely to rise and fall in parallel with the serum bilirubin in viral hepatitis

5. likely to increase in response to enzyme-inducing drug therapy

7. The serum alkaline phosphatase concentration is

1. derived from the liver, bone, small bowel and placenta

2. typically increased to more than six times normal in viral hepatitis

3. of particular prognostic value in chronic liver disease

4. increased more in extrahepatic than in intrahepatic cholestasis

5. derived mainly from gastric sinusoidal and canalicular membranes

 

8. The pathogenicity is

1. the disease caused by a pathogen

2. the ability to cause a disease

3. a pathogen power to cause severe disease

4. the ease with which a pathogen can spread in a population

5. none

9. Important host factors are

1. hygiene, previous immunity, nutrition, underlying diseases

2. pathogenicity, infectiousness, virulence

3. temperature, dust, antibiotics, pesticides

4. none

5. cellular immunity

10. Routes of transmission of infection

A. temperature,dust,humidity

B. inhalation,ingestion,inoculation

C. vectors,direct contact,fomites,inhalation,ingestion,inoculation

D. none

E. vertical transmission

1. The leading cause of illness in travelers

1. malaria

2. schistosomiasis

3. typhoid fever

4. diarrhea

5. hepatitis A

12. The Sleep disorders, mood swings and nightmares are adverse reaction associated with the use of

A. mefloquine (Lariam)

B. malarone

3. doxycyline

4. chloroquine + proguanil

5. chloroquine

13. Diagnostic methods for HIV infection are:

A. positive EIA or positive Western-blot

B. 2 x positive EIA or positive Western-blot

C. 2 x positive EIA and clinical symptoms

D. 2 x positive EIA and history of risk behavior

E. none

14. To diagnose AIDS in Poland the following are required:

A. AIDS defining condition and CD4 <200 cells/mm³

B. AIDS defining condition and history of risk behavior

C. AIDS defining condition and documented HIV infection

D. any clinical symptoms of immunodeficiency and documented HIV infection

E. none

15. Which of the below mentioned opportunistic infections does not define AIDS

A. bronchial candidiasis

B. esophageal candidiasis

C. oral candidiasis

D. central nervous system candidiasis

E. toxoplasmosis

16. Antiretroviral treatment may result in:

A. eradicating HIV and making the patient non-infectious

B. reducing viral load below the limit of detection and making the patient non-infectious

C. increasing CD4 count and making the patient non-infectious

D. reducing viral load below the limit of detection and increasing CD4 count

E. none

17. Basic data to assess the stage of HIV infection are:

A. clinical symptoms and CD4 count

B. clinical symptoms and viral load

C. clinical symptoms and the route of transmission

D. CD4 count and viral load

E. clinical symptoms

18. A study of transfusion-related infectious diseases determines that some blood donors appear to have acquired an infection via vertical transmission from mother to child. Laboratory testing strategies are devised to detect the most common of these infections and exclude such persons as blood donors. As a consequence, which of the following infectious agents is most likely to be a significant cause for rejection as a blood donor later in life.

A. Escherichia coli B. Hepatitis B virus C. Plasmodium vivax D. Candida albicans E. Pneumocystis carinii 19. A 5-year-old child is admitted to the hospital after ingesting pills he found in a cabinet at home. The child is rapidly becoming obtunded. Laboratory studies show a serum AST level of 850 UL and ALT level of 1052 UL. The childs respiratory and cardiac status remain stable. Which of the following drugs was most likely ingested: A. Acetaminophen B. Penicillin C. Aspiryn D. Sulfamethoxazole E. Codeine 20. Live viruses are usually used for active immunisation against: poliomyelitis, mumps, measles and rubella typhoid feler pertussis hepatitis B E. hepatitis D 21. Drugs that induce hepatic microsomal enzymes, all are true except : chronic ethanol ingestion glucocorticoids Grisofulvin carbamazepin Cimetidin 22. The following statements are true except : low blood urea is seen in many acute and chronic liver diseases  high blood urea in the context of severe liver damage may indicates gastroint estinal hemorrhage or hepatorenal syndrome hyponatremia is very common in severe liver disease and usually multifactorial  raised gamma GT enzyme level may occur during treatment with carbamazepin large increase in serum aminotrnsferases activity with a small rise in alkaline phsophatase activity is in favor of biliary obstruction Imaging in liver diseases, all are true except: ultrasound of the liver is a rapid, cheap and easy method and usually the first imaging to be done, yet its main limitation is that small focal lesions less than 2 cm will be missed color Doppler studies are very useful and used to investigate hepatic veins, portal vein and hepatic artery diseases C. MRI is usually used for pancreaticobiliary diseases rather than parenchymal liver diseases D.  outlining the biliary tree can be done by injecting a contrast medium into the biliary tree through the skin or by an endoscopic approach  E.  plain abdominal radiographs are very helpful in liver diseases Regarding liver biopsy, all are true except : the patient should be cooperative the PT prolongation if present, should be less than 4 seconds above the upper normal control value  severe COPD is a contraindication  marked ascites will make the procedure easier  local skin infection should not be present 25. Spontaneous bacterial peritonitis in the context of cirrhosis, all are true except : unfortunaterly, up to one third of cases the abdominal signs are mild or absent almost always a mono-microbial infection state  recurrence is common but unfortunately there is no way to prevent it  The commonest organisms are enteric gram negatives, but no source of infection is usually present   the ascitic fluid is cloudy with more than 250 neutrophils / mm3 Precipitating factors for hepatic encephalopathy in a patient with cirrhosis, all are true except occult infection aggressive diuresis  diarrhea or constipation  treamtent with oral neomycin  excesss dietary proteins The hepatitis viruses, all are true except :  hepatitis A is an RNA enterovirus which does not lead to a carrier state hepatitis B is a DNA virus that 42 nm in diameter and leads to chronic infection up to 10% of adults versus 90% of neonatal hepatitis B infection  hepatitis C is an RNA flavivirus that is the commonest cause of chronic liver disease in USA and of those infected ,up to 20 % of them will develop cirrhosis after 20 years hepatitis D is a defective RNA virus that can be prevented by preventing hepatitis B infection in high risk groups by using hepatitis B vaccine and immunoglobulin  hepatitis E is a RNA calicivirus that carries a mortality of 2% if the infection occurs in pregnancy Hepatocelluar carcinoma (HCC ), all are true except : occurs in the background of cirrhosis in up to 80% of cases  chronic hepatitis B infection is the commonest cause world-wide  may be treated by liver transplantation any patient with cirrhosis should be screened for the development of HCC by serial serum alpha fetoprotein and liver ultrasound   the fibrolammellar variant has a very poor prognosis 29. Cavitary lung lesions are seen in patients with tuberculosis and which of the following infections ? A. strongyloidiasis B. paragonimiasis C. ascariasis D. filariasis 30. Which of the following is characteristic of helminths that infect human beings? A. They usually do not multiply in the host. B. They rarely provoke an eosinophilia. C. They cause severe disease after infection with only a few parasites. D They typically cause lifelong infections. 31. Orbicularis oculi paresis with lagophthalmos and an insensitive cornea frequently leads to blindness in patients with A. leprosy B. vitamin A deficiency C. diabetes D. trachoma 32. The most frequently identified pathogen in tropical pyomyositis is: A. a Gram-negative organism B. Staphylococcus aureus C. Streptococcus pyogenes D. the pneumococcus 34. A 40-year-old patient returns from a trip to Thailand with a four-day history of fever and a one-day history of hallucinations and bloody diarrhea. The temperature is 39oC; the rest of the physical examination is normal. A thick blood film reveals that 6% of erythrocytes are parasitized with Plasmodium falciparum. Appropriate initial management includes: A. intravenous quinidine B. oral mefloquine C. oral chloroquine and pyrimethaminesulfadoxine D. oral quinine and doxycycline 35. In a case-control (retrospective) study, an odds ratio of 1.3 was found for the association between exposure X and disease Y (p <0.001). Having the combination of this odds ratio and p-value indicates that: A the association is very strong B the association is likely to be causal C a confounding factor is unlikely to account for the association D the study in which the association was found is large 36. Which of the following is the most appropriate advice for preventing acute mountain sickness? A. Take acetazolamide beginning with onset of symptoms. B. Keep fluid intake low enough to prevent pulmonary and cerebral edema. C. Spend two to three nights at 2500 to 3000 meters before going higher. D. Rest in place at onset of symptoms and breathe emergency oxygen, if available. 37. Excluding underlying diseases, the most common cause of death for United States citizens traveling to tropical countries is: A. malaria B. typhoid fever C. accidental injury D. homicide 38. A 25-year-old male presents with a threeday history of numbness and tingling in his right hand. One day preceding the development of these symptoms, he noted non-pruritic swelling of his entire forearm that lasted 36 hours and resolved spontaneously. Although he has been living in the United States for the past year, he spent the previous two years in rural Gabon, West Africa. Neurological evaluation and physical examination are significant only for decreased sensation in a glove-like distribution of the right hand. Which of the following is most likely to lead to the correct diagnosis? A. Skin snips B. C1 inhibitor levels C. Antifilarial antibody levels D. Giemsa-stained smears of blood drawn at night 39. An adult presents with acute diarrhea and a temperature of 38.6oC two days after returning from a trip to Mexico. Which of the following is the most appropriate initial step? A. Culture of a fecal specimen for Entamoeba histolytica. B. Examine a stool specimen for leukocytes and presence of blood. C. Obtain a stool culture for enteropathogenic Escherichia coli. D. Treat with metronidazole for possible amebiasis or giardiasis 40. The instructions included in a medical kit for travel should remind the user to avoid taking which of the following combinations of drugs? A. Doxycycline and bismuth subsalicylate B. Loperamide and ciprofloxacin C. Acetaminophen and mefloquine D. Diphenhydramine, trimethoprim and sulfamethoxazole 41. A form of visceral leishmaniasis lacking some of the typical features of the Disease was recognized in military personnel during the Persian Gulf war. The causative species for these cases was found to be: A. Leishmania donovani B. Leishmania major C. Leishmania aethiopica D. Leishmania tropica 42. Which of the following is the most sensitive test for suspected chronic Chagas' disease? A. Serologic test for antibodies to Trypanosoma cruzi B Culture of blood on LIT (liver infusion tryptose) medium C. Xenodiagnosis using 40 third-instar nymphs of Triatoma infestans D. Microscopic examination of peripheral blood for trypomastigotes 45. If neither individuals nor population are treated, for how long must vector control be continued to eliminate onchocerciasis from a designated region? A. Less than one year B. Five years C. 10 years D. More than 10 years 46. Diagnosis and treatment of infected persons is an important means of interrupting transmission due to which of the following? A. American cutaneous leishmaniasis B. Mediterranean visceral leishmaniasis C. Gambian trypanosomiasis D. Chagas' disease 47. Exposure to Anthrax spores requires treatment with: A. antitoxin B. antibiotics C. antibiotics and possibly vaccine D. vaccine alone 48. Victims that arrive on their own power to a health care facility immediately after being exposed to sarin nerve gas vapor require immediate: decontamination antitdote therapy A + B Observation 49. Which biological agent has the risk of person to person transmission (infected to non-infected)? A. smallpox B. tularemia C. botulizm D. anthrax 50. The imaging technique of choice to screen a patient with jaundice is: A. transhepatic cholangiogram B. liver/spleen scan C. abdominal series D. ultrasound of the upper abdomen E. ERCP (endoscopic retrograde cholangiogram) 51. A 2-year-old child presents with a one-week history of pruritic rash. You find wheals, papular vesicles, pustules and threadlike burrows on his hands, elbows, axillae, scrotum, buttocks, and feet. He has scratched several vesicles and pustules, which have ruptured and formed superficial ulcers and golden-yellow colored crusts. What organism has caused this child's primary infection? A. Pediculosis corporis B. Sarcoptes scabiei C. Toxocara canis D. Rickettsia rickettsii E. Candida albicans 52. Which of the following antibiotics would be LEAST USEFUL in covering gram-negative aerobic bacteria? A. A third generation cephalosporin B. Penicillin G C. An aminoglycoside D. Ciprofoloxacin E. Piperacillin 53. A previously healthy 24-year-old woman presents to the emergency department with a 12-hour history of a painful, swollen, red and warm right knee. Four days earlier, she had developed fever and transient migratory arthralgias. She is unable to bear weight on her right leg and appears to be in some distress because of the pain. She admits to being sexually active with multiple partners. An arthrocentesis of the right knee reveals a white blood cell count of 62,000 x 106/L (62,000/mm3), and the gram stain is positive for gram negative intracellular diplococci. Which of the following is the MOST LIKELY causative organism? A. Neiserria gonorrhea B. E. coli C. Staphylococcus aureus D. Borrelia burgdorferi E. Klebsiella pneumoniae 54. Which one of the following viral infections is not effectively prevented by vaccination? A. Hepatitis B virus B. Poliovirus C. Rhinovirus D. Rubella virus E. Smallpox virus 55. Prions cause spongiform encephalopathies including the human disease A. AIDS dementia complex. B. Creutzfeldt-Jacob disease. C. scrapie. D. subacute sclerosing panencephalopathy (SSPE). E. tropical spastic paraparesis. 56. A false positive diagnosis of an active viral infection by a serological test is MOST LIKELY a consequence of A. assay insensitivity. B. fungal contamination of the serum sample. C. presence of viral antibody titer due to prior vaccination. D. serum sample taken before sero-conversion occurs. E. storage of serum specimen at unsuitable temperature. 57. Which one of the following viruses is controlled with a killed virus vaccine? A. Chickenpox B. Enterovirus C. Influenza D. Mumps E. Parvovirus B19 58. Congenital infection by which one of the following viruses can result in birth defects? A. Adenovirus B. Cytomegalovirus C. Hepatitis B virus D. Human immunodeficiency virus E. Human papilloma virus 59. Cervical carcinoma cells typically have A. a mutant pRB gene. B. episomal human papilloma viral DNA. C. herpes simplex virus type I DNA. D. integrated human papilloma viral DNA. E. mutated cyclin D and cyclin E genes. 60. Which one of the following statements about the immune response to viruses is correct? A. Cytotoxic T cell responses play only a minor role in the immune response to viruses. B. Interferons play a major role in both innate and specific anti-viral immune responses. C. Viruses are T-independent antigens. D. T helper cells are not involved in the immune response to viruses. E. The major class of antibody produced is IgE.

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