Internal Medicine/ • Infectious Diseases

                                                                                                    I.            Common Presentations.

1.    Pruritus.

***) All of the following are cause of pruritus, except:

A.    Dermatitis herpetiformis

B.     Pheochromocytoma

C.     Uremia

D.    Prurigo nodularis

E.     Pregnancy

Answer: B* Pheochromocytoma

***) All of the following are cause of pruritus, except:

A.    Multiple sclerosis

B.     Diabetes mellitus

C.     Acromegaly

D.    Chronic renal failure

E.     Obstructive jaundice

Answer: C* Acromegaly

***) All of the following are cause of pruritus, except:

A.    Scabies

B.     Hodgkin's disease

C.     Hepatitis C

D.    Polycythemia rubra vera

E.     Rheumatoid arthritis

Answer: E* Rheumatoid arthritis

2.    Rigors.

***) Rigors are typical features of all of the following, except:

A.    Brucellosis

B.     Primary pulmonary tuberculosis

C.     Malaria

D.    Acute pyelonephritis

E.     Acute cholangitis

Answer: B* Primary pulmonary tuberculosis

***) Rigors are feature of all of the following, except:

A.    Ascending cholangitis

B.     Falciparum malaria

C.     Brucellosis

D.    Typhoid fever

E.     Rubella

Answer: E* Rubella

                                                                                                                                          II.            DRUGS.

1.    Common Drugs.

***) One of the following is bacteriostatic antibiotic: Q2012

A.    Penicillin

B.     Aminoglycosides

C.     Erythromycin

D.    Imipenem

E.     Aztreonam

Answer: C* Erythromycin

***) Which of the following antibiotics is the best treatment for pseudomembranous colitis:

A.    Ampicillin

B.     Flucloxacillin

C.     Gentamycin

D.    Vancomycin

E.     Cefuroxime

Answer: D* Vancomycin

***) One of the following is active against pseudomonas infection:

A.    Penicillin G

B.     Streptomycin

C.     Tetracycline

D.    Cefepime

E.     Cephalothin

Answer: D* Cefepime

***) Infections with Giardia lamblia are best treated with:

A.    Tetracycline

B.     Salazopyrin

C.     Gentamycin

D.    Amphotericin B

E.     Metronidazole

Answer: E* Metronidazole

***) The drug of choice for a child with pneumococcal pneumonia is:

A.    Penicillin

B.     Streptomycin

C.     Chloramphenicol

D.    Sulfa drugs

E.     Erythromycin

Answer: A* Penicillin

***) Each of the following penicillins is penicillinase resistant, except:

A.    Ampicillin

B.     Oxacillin

C.     Nafcillin

D.    Dicloxacillin

E.     Cloxacillin

Answer: A* Ampicillin

***) The following antimicrobial drugs are effective against staphylococci, except:

A.    Teicoplanin

B.     Metronidazole

C.     Imipenem

D.    Cephalexin

E.     Cloxacillin

Answer: B* Metronidazole

***) All of the following are antiviral drugs, except:

A.    Acyclovir

B.     Vidarabine

C.     Amphotericin B

D.    Ganciclovir

E.     Interferon

Answer: C* Amphotericin B

***) All of the following are antiviral drugs, except:

A.    Acyclovir

B.     Zidovudine

C.     Vidarabine

D.    Interferon

E.     Griseofulvin

Answer: E* Griseofulvin

                                                                                                        III.            Specific Infections.

1.    Gastroenteritis.

***) One of the following is the most common cause of diarrhea: Q2012

A.    Bacterial

B.     Fungal

C.     Viral

D.    Parasitic

E.     None of above

Answer: A* Bacterial

***) The following is correct about food poisoning, except:

A.    Salmonella food poisoning is common

B.     Incubation period of salmonella food poisoning is 12-48 hours

C.     Incubation period of staphylococcal food poisoning is 1-8 hours

D.    Amanita poisoning is a type of mushroom poisoning

E.     Clostridium tetani can cause food poisoning

Answer: E* Clostridium tetani can cause food poisoning

***) All of the following can cause food poisoning by causing gastrointestinal tract infection, except:

A.    Salmonella

B.     Streptococcus

C.     Staphylococcus

D.    Vibrio parahaemolyticus

E.     Fungus

Answer: B* Streptococcus

***) Which of the following organism is not a cause of invasive diarrhea:

A.    Salmonella

B.     Giardia

C.     Campylobacter

D.    Shigella

E.     Amebiasis

Answer: B* Giardia

***) All of the following can cause food poisoning by producing toxin, except:

A.    Staphylococcus

B.     Clostridium perfringens

C.     Clostridium botulinum

D.    Salmonella

E.     Bacillus cereus

Answer: D* Salmonella

***) The incubation period of a food poisoning by chemical poisons is usually:

A.    Less than 1 hour

B.     8 hours

C.     12 hours

D.    18 hours

E.     More than 18 hours

Answer: A* Less than 1 hour

***) Which one of the following is usually not a feature of staphylococcal food poisoning:

A.    Abdominal cramps

B.     Fever

C.     Hypotension

D.    Vomiting

E.     Diarrhea

Answer: B* Fever

***) The characteristic incubation period for staphylococcus aureus food poisoning is:

A.    1 to 6 hrs

B.     8 to 24 hrs

C.     1 to 4 days

D.    6 to 15 days

E.     15 to 21 days

Answer: A* 1 to 6 hrs

***) Regarding staphylococcal food poisoning all of the following statements are true, except:

A.    Contaminated meats and confectionery constitute the most outbreak

B.     Vomiting and severe abdominal cramps are prominent symptoms

C.     The acute symptoms usually subside within 12 hours

D.    Central nervous system manifestations are usually present

E.     Majority of patients require no specific treatment

Answer: D* Central nervous system manifestations are usually present

***) Staphylococcal food poisoning is characterized by all of the following, except:

A.    Short incubation period

B.     It is a common source-type of epidemic

C.     Fever is a common symptom of the disease

D.    Symptoms are usually of short duration

E.     The diseases is usually brief and only requires rest and sedation

Answer: C* Fever is a common symptom of the disease

***) Salmonella can reach the food from one of the following:

A.    Animal excreta at time of slaughter

B.     From human excreta

C.     Raw to cooked food by hand, surfaces and utensils in kitchen

D.    Water polluted by sewage

E.     All of above

Answer: E* All of above

***) The incubation period of a food born salmonella outbreak is:

A.    30-60 minutes

B.     4 hours

C.     1 day

D.    4 days

E.     30 days

Answer: C* 1 day

***) A child complaining of bloody diarrhea, vomiting and abdominal pain 20 hours after eating a chicken mostly likely has:

A.    Staphylococcal food poisoning

B.     Botulism

C.     Appendicitis

D.    Salmonella food poisoning

E.     Meckel's diverticulitis

Answer: D* Salmonella food poisoning

***) Which of the following organisms are used for routine testing of water:

A.    Typhoid

B.     Salmonella

C.     Coliform

D.    Streptococci

E.     Staphylococci

Answer: C* Coliform

2.    Malaria.

***) Which of the following drugs is useful for Plasmodium falciparum malaria chemoprophylaxis:

A.    Emetine hydrochloride

B.     Trimetoprim

C.     Chloroquine

D.    Metronidazole

E.     Rifampicin

Answer: C* Chloroquine

3.    Tuberculosis (TB).

***) All of the following statements regarding tuberculosis are true, except:

A.    The risk of developing TB disease is greatest within the first year following infection

B.     Most cases of tuberculosis occur as a result of primary infection

C.     Isoniazid chemoprophylaxis may be given to selected high risk patients over 35 years of age

D.    Incidence of the disease among elderly is higher than that of middle aged

E.     Most cases of tuberculosis can be successfully treated with antituberculous drugs

Answer: B* Most cases of tuberculosis occur as a result of primary infection

***) One of the following is a chronic specific inflammation:

A.    Gonorrhea

B.     AIDS

C.     Tuberculosis

D.    Viral hepatitis

E.     Fibroadenosis

Answer: C* Tuberculosis

***) One of the following is etiological agent of Pott’s disease:

A.    Actinomyces israelii

B.     Haemophilus influenza

C.     Treponema pallidum

D.    Mycobacterium tuberculosis

E.     Coccidioides immitis

Answer: D* Mycobacterium tuberculosis

***) The mode of transmission of tuberculosis is mostly:

A.    Droplet

B.     Airborne

C.     Common vehicle

D.    Contaminated hands

E.     Sexual

Answer: B* Airborne

***) Mycobacterium tuberculosis is characteristically transmitted by one individual to another by:

A.    Airborne transmission

B.     Contact with blood products

C.     Food contamination

D.    Contaminated water supply

E.     Insect vector

Answer: A* Airborne transmission

***) Only one of the following is a site of primary TB:

A.    Bone

B.     Testis

C.     Kidney

D.    Tonsil

E.     Stomach

Answer: D* Tonsil

***) All of the following may be sites of primary TB, except:

A.    Skin

B.     Bone

C.     Lung

D.    Ileum

E.     Tonsil

Answer: B* Bone

***) A positive tuberculin test (PPD) is considered when the induration diameter is:

A.    3millimeter

B.     5millimeter

C.     7millimeter

D.    9millimeter

E.     10millimeter and more

Answer: E* 10millimeter and more

***) The least amount of reaction which would be considered a definite positive reaction to PPD in children is:

A.    Any reaction

B.     Over 5mm erythema

C.     Over 5mm induration

D.    Over 10mm erythema

E.     Over 10mm induration

Answer: E* Over 10mm induration

***) All the following are anti tuberculosis drugs except:

A.    Isoniazid

B.     Rifampicin

C.     Methimazole

D.    Pyrazinamide

E.     Ethambutol

Answer: C* Methimazole

***) All of the following are anti-tuberculous drugs, except:

A.    Streptomycin

B.     Ethambutol

C.     Kanamycin

D.    Rifampicin

E.     Isonicotinic acid hydrazide (INH)

Answer: C* Kanamycin

***) All of the following are anti-tuberculous drugs, except:

A.    Rifampicin

B.     Isoniazid

C.     Co-trimoxazole

D.    Pyrazinamide

E.     Ethambutol

Answer: C* Co-trimoxazole

***) Contacts with a patient having TB who recently changed from negative to positive for PPD test should receive:

A.    INH

B.     Rifampicin

C.     INH + Rifampicin

D.    Streptomycin

E.     INH + Rifampicin + Ethambutol

Answer: A* INH

***) One of the following anti-tuberculous treatments causes optic neuritis:

A.    Pyrazinamide

B.     INH

C.     Rifampicin

D.    Streptomycin

E.     Ethambutol

Answer: E* Ethambutol

4.    Herpes Virus Infections.

***) Herpes Zoster occurs after infected with: Q2012

A.    Smallpox

B.     Chickenpox

C.     Measles

D.    Mumps

E.     Rubella

Answer: B* Chickenpox

5.    Infectious Mononucleosis.

***) All of the following are true about infectious mononucleosis, except:

A.    Caused by Epstein-Barr herpes virus

B.     Myocarditis may occur

C.     Splenic rupture is a recognized complication

D.    Liver function tests are usually normal

E.     Blood smear shows atypical large lymphocytes and lymphocytosis

Answer: D* Liver function tests are usually normal

***) All of the following about infectious mononucleosis (glandular fever) is correct, except:

A.    Sore throat

B.     Cervical lymphadenopathy

C.     Ampicillin is a drug of choice

D.    Splenomegaly

E.     Mild hepatitis is common

Answer: C* Ampicillin is a drug of choice

6.    Toxoplasma.

***) Acquisition (transmission) of Toxoplasma occurs in all of the following situations, except:

A.    Contact with an acutely infected adult

B.     Contact with cat feces of an infected cat

C.     Ingestion of inadequately cooked meat of an infected cow

D.    Blood transfusion from an acutely infected person

E.     Transplacentally to the fetus from an acutely infected mother

Answer: A* Contact with an acutely infected adult

***) All of the following diseases may be transmitted by milk, except:

A.    Brucellosis

B.     Tuberculosis

C.     Staphylococcus food poisoning

D.    Q fever

E.     Toxoplasmosis

Answer: E* Toxoplasmosis

7.    Viral Hepatitis.

***) All of the following about hepatitis infection are false, except: Q2012

A.    Hepatitis B is transmitted by feco-oral route

B.     Vaccination is available for hepatitis C

C.     Incubation period for hepatitis A is 14-21 days

D.    Hepatitis D is a DNA virus

E.     Interferon treatment is required for hepatitis E

Answer: C* Incubation period for hepatitis A is 14-21 days

***) In hepatocellular carcinoma, all the following are true except: Q2012

A.    It can be caused by hepatitis A

B.     It may lead to cirrhosis

C.     It leads to increased alfa feto protein

D.    It may cause fever

E.     It can be associated with polycythemia

Answer: A* It can be caused by hepatitis A

***) All the following are DNA viruses except: Q2012

A.    Rubella virus

B.     Herpes simplex virus

C.     Hepatitis B

D.    Adenovirus

E.     Epstein-Bar virus

Answer: A*Rubella

***) All of the following about hepatitis B vaccination are false, except: Q2012

A.    Hepatitis B vaccine is given in 2 doses

B.     Vaccine is protective for maximum 10 years after administration

C.     Vaccine is safe in immune-compromised persons

D.    Vaccine offers also partial protection against hepatitis C infection

E.     Vaccine should not be used in children younger than 10 years of age

Answer: C* Vaccine is safe in immune-compromised persons

***) The incubation period of infectious hepatitis is:

A.    3 days

B.     5 days

C.     7 days

D.    10 days

E.     Over 15 days

Answer: E* Over 15 days

***) Patients with hepatitis A are most infectious:

A.    Infectious during the rise of bilirubin

B.     Infectious during the rise of aspartate aminotransferase (AST) serum level

C.     Infectious two weeks after jaundice subsides

D.    Infectious when both bilirubin and AST are elevated

E.     Infectious before the appearance of jaundice

Answer: E* Infectious before the appearance of jaundice

***) In hepatitis A infection all of the following are true, except:

A.    Transmitted by feco-oral route

B.     Cause marked elevation on the liver enzymes

C.     Chronic active hepatitis is a recognized complication

D.    The disease gives long life immunity

E.     Infectivity is high before the appearance of jaundice

Answer: C* Chronic active hepatitis is a recognized complication

***) Regarding hepatitis A all are true, except:

A.    The vaccine is available after the age of one year

B.     It is more severe in children than in adults

C.     In small children most cases are anicteric

D.    May present an anicteric in some cases less than 5 years of age

E.     No specific treatment needed in most cases (prognosis is usually good)

Answer: B* It is more severe in children than in adults

***) Chronic carrier is an important source of spread of all of the following, except:

A.    Amoebic dysentery

B.     Typhoid

C.     Bacillary dysentery

D.    Cholera

E.     Infectious hepatitis (hepatitis A)

Answer: E* Infectious hepatitis (hepatitis A)

***) All of the following about hepatitis B infection are true, except:

A.    May be transmitted sexually

B.     Can cause chronic active hepatitis

C.     Hepatoma is recognized complication

D.    Vaccination is available

E.     Caused by RNA virus

Answer: E* Caused by RNA virus

***) In Hepatitis B, one is false:

A.    Caused by RNA virus

B.     Produces chronic hepatitis in 5-10% of cases

C.     Infection has longer incubation period than hepatitis A

D.    Is sexually transmitted

E.     Infection can be prevented by the use of vaccine

Answer: A* Caused by RNA virus

***) All of the following about hepatitis B infection are true, except:

A.    May be transmitted sexually

B.     Can cause chronic active hepatitis

C.     Hepatoma is recognized complication

D.    Vaccination is available

E.     Recovery is invariable

Answer: E* Recovery is invariable

***) Regarding Viral hepatitis all are true except:

A.    Hepatitis A is the commonest

B.     All viruses are RNA except hepatitis B is DNA

C.     Hepatitis A and E don't produce chronic illness

D.    Transmission is similar in all types

E.     Hepatitis C is responsible for most chronic cases

Answer: D* Transmission is similar in all types

***) The greatest risk for infection transmitted by blood transfusion is present in one of the following:

A.    Syphilis

B.     Hepatitis B

C.     Hepatitis C

D.    Human immunodeficiency virus (HIV)

E.     Urinary tract infection

Answer: C* Hepatitis C

***) All of the following are the causes of chronic hepatitis, except:

A.    Hepatitis B

B.     Hepatitis C

C.     Methyldopa

D.    Alpha-1-antitrypsin deficiency

E.     Ulcerative colitis

Answer: E* Ulcerative colitis

8.    AIDS.

***) All of the following about acute HIV infection are true, except: Q2012

A.    It is associated with a very high viral load

B.     It occurs in at least 70% of HIV infection

C.     Patients have low infectiousness in this stage

D.    Maculopapular rash can occur in the upper trunk

E.     It is diagnosed by viral PCR

Answer: C* Patients have low infectiousness in this stage

***) All of the following about acquired immunodeficiency syndrome (AIDS) are true, except:

A.    It is transmitted by sexual contact

B.     It can be transmitted by blood transfusion

C.     The incubation period varying from one year to ten years

D.    Kaposi's sarcoma can occur

E.     Vaccine is available

Answer: E* Vaccine is available

***) All of the following about AIDS are true, except:

A.    Can be transmitted from mother to fetus

B.     Is caused by retrovirus

C.     Causes dementia

D.    Pneumocystis carinii pneumonia is a recognized complication

E.     T4 T8 ratio is high

Answer: E* T4 T8 ratio is high

***) All of the following about AIDS are true, except:

A.    May be transmitted through kidney transplantation

B.     CD4 count is normal or raised

C.     Carriers are infectious

D.    Affects mainly the helper T-cells (T4)

E.     Affect the central nervous system

Answer: B* CD4 count is normal or raised

9.    Candida albicans.

***) All of the following about candidiasis are true, except:

A.    It is more common in diabetes

B.     It may complicate treatment with antibiotics

C.     It may cause vaginitis

D.    It is usually accompanied by systemic upset

E.     It may be seen in immune compromised patients

Answer: D* It is usually accompanied by systemic upset

***) Candidiasis may complicate all of the following, except:

A.    Diabetes mellitus

B.     Hodgkin's disease

C.     Antibiotic therapy

D.    AIDS

E.     Thyrotoxicosis

Answer: E* Thyrotoxicosis

***) All of the following conditions predispose to Candida infection, except:

A.    Pregnancy

B.     Diabetes mellitus

C.     Hypoparathyroidism

D.    Anhidrosis

E.     Hypothyroidism

Answer: D* Anhidrosis

10.           Gram Positive Infections.

***) The most common infecting organism in acute lymphangitis is:

A.    Streptococcus

B.     Staphylococcus

C.     Pneumococcus

D.    E.coli

E.     Pseudomonas

Answer: A* Streptococcus

***) Nervous system manifestations of diphtheria occur:

A.    Earlier than myocarditis

B.     At the same time as myocarditis

C.     About 5 days after onset of illness

D.    Weeks after onset of illness

E.     4 months after onset of illness

Answer: D* Weeks after onset of illness

***) All of the following about diphtheria toxin are true, except:

A.    It is an exotoxin

B.     It blocks protein synthesis

C.     It leads to neuritis

D.    It leads to carditis

E.     It is neutralized by antitoxin even after penetration into the cells

Answer: E* It is neutralized by antitoxin even after penetration into the cells

11.           Gram Negative Infections.

***) All the following are Gram negative bacilli, except:

A.    Salmonella

B.     Klebsiella

C.     Listeria

D.    E.coli

E.     Campylobacter

Answer: C* Listeria

12.           Brucellosis.

***) Regarding brucellosis, one of the following is true: Q2012

A.    It is caused by gram positive bacilli

B.     The most virulent form is brucella abortus

C.     Treatment can be achieved by doxycycline and rifampin for 6 weeks

D.    Meningitis is the commonest cause of death

E.     Diagnosis is obtained by blood cultures in chronic cases

Answer: C* Treatment can be achieved by doxycycline and rifampin for 6 weeks

***) 20 years old male presented with fever, arthritis, increase in ESR and brucella titer, the best management is: Q2012

A.    Repeat titer in 3 months

B.     6 weeks of doxycycline and rifampin

C.     6 weeks of doxycycline

D.    6 weeks of rifampin

E.     2 weeks of doxycycline and rifampin

Answer: B* 6 weeks of doxycycline and rifampin

***) All of the following about brucellosis are true, except:

A.    It is caused by gram-negative coccobacillus

B.     Orchitis may occur

C.     Benzylpenicillin is the antibiotic of choice

D.    Osteomyelitis may occur

E.     Infective endocarditis is the commonest cause of death

Answer: C* Benzylpenicillin is the antibiotic of choice

l

***) All of the following about brucellosis are true, except:

A.    It is occupational disease

B.     It causes peripheral neuropathy

C.     It causes mental depression

D.    It causes leucocytosis

E.     Infective endocarditis is a recognized complication

Answer: D* It causes leucocytosis

***) All of the following about brucellosis are true, except:

A.    It is a recognized cause of splenomegaly

B.     It may present with backache

C.     Infective endocarditis may occur

D.    Man to man transmission is common

E.     Rifampicin may be used in the treatment

Answer: D* Man to man transmission is common

***) All of the following about brucellosis are true, except:

A.    Brucella is a gram-negative coccobacillus

B.     The incubation period varies from 1 to 3 weeks

C.     The onset of acute brucellosis is insidious

D.    Vaccine is available for use in humans

E.     Doxycycline with rifampicin usually effective

Answer: D* Vaccine is available for use in humans

***) Concerning brucellosis all of the following are true, except:

A.    Cows and goats are the common source of infection

B.     Ampicillin is the drug of choice

C.     Fever, sweating and poor appetite are common

D.    The course of treatment is 4-6 weeks

E.     Joint pains is a common feature in children

Answer: B* Ampicillin is the drug of choice

***) Regarding brucellosis, one of the following is true:

A.    It can't be transmitted from person to person

B.     It can be transmitted by milk and milk products

C.     It is mainly an occupational disease

D.    It is a worldwide disease mainly in the third world countries

E.     All of above

Answer: E* All of above

***) Regarding brucellosis, one of the following statements is true:

A.    Caused by gram positive bacteria

B.     Skin test is diagnostic

C.     It is a multisystem disease

D.    Man to man transmission

E.     The drug of choice is ampicillin

Answer: C* It is a multisystem disease

***) Characteristic features of brucellosis include the following, except:

A.    Leucocytosis

B.     Spondylitis

C.     Marked sweating

D.    Mental depression

E.     Fever

Answer: A* Leucocytosis

***) Penicillin could be a drug of choice for treatment of the following, except:

A.    Scarlet fever

B.     Brucellosis

C.     Pneumococcal meningitis

D.    Streptococcal skin infection

E.     Tonsillitis

Answer: B* Brucellosis

13.           Tetanus.

***) All of the following are true about tetanus, except:

A.    Trismus is characteristic

B.     The longer incubation period is better in the prognosis

C.     CSF is usually normal

D.    Temperature is usually very high

E.     If the patient survives, recovery is complete

Answer: D* Temperature is usually very high

***) Concerning tetanus, one is not correct:

A.    It is the result of wound infection by gram-positive anaerobic bacilli of clostridia group

B.     There are exotoxic noninvasive organisms

C.     These organisms live normally and actively in soil

D.    This disease is best prevented by active immunization and proper wound management

E.     The usual cause of death in established tetanus is respiratory failure

Answer: B* There are exotoxic noninvasive organisms

***) Concerning tetanus, one is not correct:

A.    It's the result of wound infection by gram negative anaerobic rod of clostridia group

B.     There are exotic noninvasive organism

C.     This disease is best prevented by active immunization and proper wound management

D.    The usual cause of death is established tetanus is respiratory failure

E.     Mild cases of tetanus can be treated with tetanus immunoglobulin IV or IM

Answer: A* It's the result of wound infection by gram negative anaerobic rod of clostridia group

***) The cause of death in established tetanus is:

A.    Septic shock

B.     Heart failure

C.     Renal failure

D.    Respiratory failure

E.     Pulmonary embolism

Answer: D* Respiratory failure

***) All of the following statements of anti tetanus immunization are true, except:

A.    To prevent tetanus neonatorum women should be actively immunized by puberty

B.     Immunization during pregnancy is avoided because of its harmful effect on the fetus

C.     Recommended for universal use regardless of age

D.    Important for workers in contact with soil, sewage or domestic animals

E.     For severe wounds, give a booster if more than 5 years have elapsed since the last dose

Answer: B* Immunization during pregnancy is avoided because of its harmful effect on the fetus

***) All of the following diseases may be water born, except:

A.    Typhoid fever

B.     Tetanus

C.     Bacillary dysentery

D.    Cholera

E.     Infectious hepatitis (hepatitis A)

Answer: B* Tetanus

14.           Typhoid Fever.

***) All of the following about typhoid fever are true, except:

A.    Is caused by salmonella typhi

B.     Leucopenia is present

C.     Blood culture is positive during the first week

D.    Chloramphenicol is the drug of choice

E.     Severe diarrhea is a prominent symptom

Answer: E* Severe diarrhea is a prominent symptom

***) All of the following about typhoid fever are true, except:

A.    Humans are only reservoirs

B.     Headache is a prominent symptom

C.     Rose spots occur during the second week

D.    Splenomegaly can occur

E.     Leucocytosis is usually present

Answer: E* Leucocytosis is usually present

***) During the first week of typhoid fever, all of the following may be found, except:

A.    Headache

B.     Constipation

C.     A palpable spleen

D.    Sore throat

E.     Positive blood culture

Answer: C* A palpable spleen

***) The followings are features of the first week of typhoid fever, except:

A.    Constipation

B.     Leucocytosis

C.     Dry cough

D.    Positive blood culture

E.     Headache

Answer: B* Leucocytosis

***) The following are common features of typhoid fever, except:

A.    Diarrhea

B.     Dysphagia

C.     Headache

D.    Splenomegaly

E.     Leucocytosis

Answer: B* Dysphagia

***) A 20 years old patient presented with 5 days history of gradually increasing fever, headache and constipation. Provisional diagnosis of typhoid fever was suggested. Diagnosis can be best confirmed at this stage by which of the following:

A.    Widal test

B.     Blood cultured

C.     Urine culture

D.    Stool culture

E.     Clinical examination

Answer: B* Blood cultured

***) All of the following drugs may be used in the treatment of typhoid fever, except:

A.    Chloramphenicol

B.     Ampicillin

C.     Cotrimoxazole

D.    Ceftriaxone

E.     Tetracycline

Answer: E* Tetracycline

15.           Bacillary Dysentery.

***) All of the following about Shigellosis are true, except:

A.    The inoculum size is very small

B.     Enterotoxin is produced

C.     The major disease manifestations are due to colonic invasion

D.    Bacteriemia occurs in approximately one third of the patients

E.     Man is the only host

Answer: D* Bacteriemia occurs in approximately one third of the patients

***) The most important reservoir of shigella (bacillary dysentery) is:

A.    Bird

B.     Rodent

C.     Dog

D.    Cow

E.     Men

Answer: E* Men

16.           Cholera.

***) The following about cholera are true, except:

A.    Individuals with achlorhydria are more susceptible to infection

B.     Disease is mediated by exotoxin

C.     Causes metabolic acidosis

D.    Usually involves huge bowels

E.     Tetracycline is used on then treatment

Answer: B* Disease is mediated by exotoxin

***) All of the following are true about cholera, except:

A.    Carriers exceed those with symptoms and carrier state can persist for a few months

B.     The disease is caused by enterotoxin elaborated by the organism

C.     The disease is transmitted through contaminated water or food

D.    Tetracycline shortens the period of communicability

E.     Mass vaccination is the best method to control the spread of the disease

Answer: A* Carriers exceed those with symptoms and carrier state can persist for a few months

***) All of the following factors shorten the viability period of Vibrio cholera, except:

A.    Dryness

B.     Chemotherapeutics

C.     Coldness

D.    High temperatures

E.     Disinfectants

Answer: C* Coldness

17.           Spirochetes.

***) All of the following are viral disease, except:

A.    Warts

B.     AIDS

C.     Herpes zoster

D.    Lyme disease

E.     Varicella

Answer: D* Lyme disease

18.           Rabies.

***) The incubation period for rabies is:

A.    24 hours

B.     2 to 3 days

C.     2 to 3 weeks

D.    1 to 2 months

E.     6 to 12 months

Answer: D* 1 to 2 months

***) Immunization against rabies (post-exposure) is given in 6 doses as follows:

A.    At 0, 5, 9, 14, 60, 90

B.     At 0, 5, 14, 21, 30, 120

C.     At 0, 3, 7, 14, 30, 90

D.    At 0, 3, 10, 21, 60,120

E.     At 0, 3, 30, 60, 90,120

Answer: C* At 0, 3, 7, 14, 30, 90

19.           Gastrointestinal Protozoa.

***) Which of the following areas of the large bowel most frequently involved by amebiasis:

A.    Rectum

B.     Sigmoid

C.     Cecum

D.    Splenic flexure

E.     Transverse colon

Answer: C* Cecum

***) The drug of choice in treatment of amoebic hepatitis is:

A.    Methicillin

B.     Rifampicin

C.     Mebendazole

D.    Metronidazole

E.     Omeprazole

Answer: D* Metronidazole

20.           Leishmaniasis.

***) Cutaneous leishmaniasis can be transmitted through the:

A.    Bite of an infective female anopheles mosquito

B.     Bite of infective female sandflies

C.     Bite of infective glossina (tsetse) fly

D.    Bite of infective aedes mosquitoes

E.     Bite of infective male sandflies

Answer: B* Bite of infective female sandflies

***) Airborne transmission occurs in all of the following, except:

A.    Streptococcal infection

B.     Brucellosis

C.     Tuberculosis

D.    Leishmaniasis

E.     Anthrax

Answer: D* Leishmaniasis

21.           Nematodes (Roundworms).

***) Concerning ascariasis all of the following are true, except:

A.    The parasite responsible is around worm

B.     Pulmonary involvement may be manifested as Loeffler syndrome

C.     Intestinal obstruction is the most common complaint

D.    Infective eggs are hatched in the duodenum

E.     Mebendazole is an effective therapy

Answer: D* Infective eggs are hatched in the duodenum

***) All of the following are signs and symptoms characterizing ascariasis, except:

A.    Urticaria

B.     Cough and hemoptysis

C.     Eosinophiles

D.    Splenomegaly

E.     Vague abdominal pain

Answer: D* Splenomegaly

***) Intestinal obstruction is most likely to occur as a complication of infestation with:

A.    Enterobius vermicularis

B.     Necator americanus

C.     Ascaris lumbricoides

D.    Strongyloides stercoralis

E.     Toxocara canis

Answer: C* Ascaris lumbricoides

22.           Enterobius vermicularis (Pinworm).

***) Pruritus ani in childhood is usually due to:

A.    Hemorrhoids

B.     Polyps

C.     Prolapsed rectum

D.    Soap allergy

E.     Pine worms

Answer: E* Pine worms

23.           Schistosomiasis.

***) Bilharziasis is transmitted through

A.    Culex mosquito

B.     Anopheles mosquito

C.     Cercaria in polluted water

D.    Direct contact with patients

E.     Contaminated food

Answer: C* Cercaria in polluted water

***) All of the following diseases are susceptible to chlorinating, except:

A.    Giardiasis

B.     Leptospirosis

C.     Bacillary dysentery

D.    Typhoid fever

E.     Schistosomiasis

Answer: E* Schistosomiasis

24.           Zoonosis.

***) Which of the following is not a zoonosis:

A.    Salmonellosis

B.     Cholera

C.     Brucellosis

D.    Anthrax

E.     Rabies

Answer: B* Cholera

***) All of the following are considered zoonosis diseases, except:

A.    Anthrax

B.     Rabies

C.     Leptospirosis

D.    Diphtheria

E.     Brucellosis

Answer: D* Diphtheria

25.           Meningitis.

***) One of the following is the most common cause of meningitis: Q2012

F.      Bacterial

G.    Fungal

H.    Viral

I.        Parasitic

J.       None of above

Answer: C* Viral

***) 35 years old male presented with headache, fever and positive meningeal signs, the next step in management is: Q2012

A.    Give ceftriaxone and vancomycin

B.     Do CT scan

C.     Do LP

D.    Do CXR

E.     Do blood culture

Answer: A* Give ceftriaxone and vancomycin

***) Post traumatic meningitis all true except:

A.    Occurs within 2 weeks in most of the cases

B.     Most of the cases are associated with base skull fracture

C.     Antibiotics is the main line of treatment

D.    CSF fistula should be treated if present

E.     Gram positive cocci are the most common organisms to cause infection

Answer: E* Gram positive cocci are the most common organisms to cause infection

***) The most common organism in post traumatic meningitis is:

A.    Staphylococcus

B.     Meningococcus

C.     Pneumococcus

D.    Streptococcus

E.     H.influenza

Answer: C* Pneumococcus

***) A gram stain report from cerebrospinal fluid CSF showed gram positive diplococci, the organism is:

A.    Neisseria meningitidis

B.     B hemolytic streptococci group B

C.     Streptococcus pneumonia

D.    Haemophilus influenzae

E.     Escherichia coli

Answer: C* Streptococcus pneumonia

***) Meningitis caused by haemophilus influenzae type B is most common in children of age:

A.    Under 2 months

B.     3 months - 4 years

C.     5 years - 8 years

D.    8 years - 10 years

E.     Over 11 years of age

Answer: B* 3 months - 4 years

***) A 15 months old child developed hydrocephalus following meningitis. The most likely causative organism is:

A.    E.Coli

B.     Salmonella

C.     Meningococci

D.    H.influenza

E.     Listeria monocytogenes

Answer: D* H.influenza

***) The most common organism causing meningitis in toddlers (6 months - 3 years) is:

A.    Diplococcus pneumonia

B.     Group C Neisseria meningitides

C.     Group A hemolytic streptococcus

D.    Haemophilus influenzae type B

E.     E.Coli

Answer: D* Haemophilus influenzae type B

***) At what age meningitis cannot be excluded with confidence in children presenting with febrile convulsions:

A.    Five years

B.     Four years

C.     Three years

D.    Nine months

E.     All ages

Answer: E* All ages

***) Incubation period meningococcal meningitis is usually:

A.    7-10 days

B.     2-3 days

C.     8-15 days

D.    3 weeks

E.     10-20 days

Answer: D* 2-3 days

***) In bacterial meningitis affecting a 15 years old boy which of the following organisms is most often implicated:

A.    Streptococcus

B.     Staphylococcus

C.     Meningococcus

D.    Haemophilus influenza

E.     Pneumococcus

Answer: E* Pneumococcus

***) Which one of the following is the earliest sign in a newborn with sepsis and meningitis:

A.    Refusal of feeding

B.     Hyperirritability

C.     Respiratory distress

D.    Stiff neck

E.     Jaundice

Answer: A* Refusal of feeding

***) The following are typical changes in CSF in pyogenic meningitis, except:

A.    High protein

B.     High glucose

C.     High polymorph cells

D.    High CSF pressure

E.     Turbid CSF

Answer: B* High glucose

***) Characteristic cerebrospinal fluid findings in viral meningitis don’t include:

A.    White cell count may be low

B.     There may be early polymorphonuclear cell reaction

C.     Normal sugar content

D.    Elevated protein

E.     Positive direct smear for AFB

Answer: E* Positive direct smear for AFB

***) The best treatment of bacterial meningitis in 12 months old patient is:

A.    Ampicillin

B.     Amikacin and ampicillin

C.     Rifampicin

D.    Chloramphenicol and ampicillin

E.     Cefalotin and gentamycin

Answer: D* Chloramphenicol and ampicillin

***) Empirical treatment of neonatal meningitis is:

A.    Ampicillin and vancomycin

B.     Vancomycin and ceftriaxone

C.     Ampicillin and cefotaxime

D.    Amikacin and cefotaxime

E.     Cefuroxime and ampicillin

Answer: C* Ampicillin and cefotaxime

***) The following about meningococcal meningitis are true, except:

A.    Infection is transmitted by droplet

B.     May cause convulsions

C.     CSF glucose is low

D.    It is the commonest form in adult

E.     Causes petechial rash

Answer: D* It is the commonest form in adult

***) The following about meningococcal meningitis are true, except:

A.    Causes petechial skin rash

B.     CSF is normal

C.     Penicillin is the drug of choice

D.    Vaccination is helpful

E.     Rifampicin is the drug of choice for the close contacts

Answer: B* CSF is normal

***) The most common route of infection of most types of meningitis is the:

A.    Blood stream

B.     Direct extension from the middle ear

C.     Extension from a skull fracture

D.    Extension from the cribriform plate

E.     Wounds

Answer: A* Blood stream

***) All of the following are indications for lumbar puncture, except:

A.    Diagnosis of meningitis

B.     Diagnosis of multiple sclerosis

C.     Suspicion of a mass lesion in the brain

D.    Benign intracranial hypertension

E.     Intrathecal injection of drugs

Answer: C* Suspicion of a mass lesion in the brain

26.           Encephalitis.

***) Each of the following statements is true about encephalitis, except:

A.    CSF sugar is either normal or little raised

B.     In most cases the etiology is viral agents

C.     Prognosis is generally good

D.    CSF cells are mainly segmented neutrophils

E.     Some meningeal signs may present

Answer: C* Prognosis is generally good

***) The viral encephalitis is specifically treated with:

A.    Penicillin

B.     Hyperimmune rabbit serum

C.     Gamma globulin

D.    Steroids

E.     Supportive treatment

Answer: E* Supportive treatment

27.           Osteomyelitis.

***) The usual causative microorganism of the hematogenous acute osteomyelitis is:

A.    Beta-hemolytic streptococcus

B.     E.coli

C.     Staphylococcus aureus

D.    Mycobacterium TB

E.     Clostridium

Answer: C* Staphylococcus aureus

***) The commonest causative organism in osteomyelitis is:

A.    Pseudomonas

B.     Tubercle bacillus

C.     Streptococcus

D.    Treponema pallida

E.     Staphylococcus

Answer: E* Staphylococcus

***) Regarding acute osteomyelitis all are true, except:

A.    Usually caused by hematogenous spread

B.     Most commonly caused by staphylococcus aureus

C.     Often yields positive blood culture

D.    May affect more than one bone

E.     X-ray is diagnostic in the early course of the disease

Answer: E* X-ray is diagnostic in the early course of the disease

***) X-ray findings in acute hematogenic osteomyelitis are visible after:

A.    1 week

B.     2 weeks

C.     3 weeks

D.    4 weeks

E.     5 weeks

Answer: B* 2 weeks

***) A school boy who presents with a three days illness caused by acute osteomyelitis is likely to have all of the following, except:

A.    Severe localized pain

B.     Fever

C.     Neutrophil leucocytosis

D.    Abnormal limb X-ray

E.     A blood culture growth of staphylococci

Answer: D* Abnormal limb X-ray