DEPARTMENT OF MEDICINE

4th RESIDENTS EXAM

INFECTIOUS DISEASE
June 27, 2008
MULTIPLE TRUE OR FALSE:
There are 5 statements after each question. Determine whether each statement is true or false. On the answer sheet, place
an X in the box corresponding to your answer.
1.

Temperature-pulse dissociation (relative bradycardia) occurs in the following infectious disease/s (HPIM 16 th ed, p. 107):
A. Typhoid fever
B. Disseminated tuberculosis
C. Brucellosis
D. Malaria
E. Leptospirosis

2.

The following statement/s is/are TRUE regarding the use of antipyretics in fever (HPIM 16 th ed, p. 107):
A. Acetaminophen is a poor cyclooxygenase inhibitor in peripheral tissue and has no significant anti-inflammatory
activity.
B. Acetaminophen is preferred over aspirin because it has better antipyretic activity.
C. NSAIDs such as indomethacin and ibuprofen also have excellent antipyretic activity.
D. Because fever acts as an adjuvant to the immune system, its treatment may slow down the resolution of
common viral and bacterial infections.
E.
Although glucocorticoids have excellent anti-inflammatory activity, they have minimal effect on fever.

3.

A 66 year old diabetic male was admitted at the ER for markedly severe pain of his right leg associated with spiking fever.
On PE, his right leg is erythematous, shiny, swollen and exquisitely tender. The following statement/s is/are TRUE of this
condition (HPIM, p. 711):

A.
B.
C.
D.
E.

Most common organisms causing this condition are group A streptococci, coagulase negative staphylococci,
and Pseudomonas aeruginosa.
Patients may present with bacteremia and hypotension without other organ-system failure.
In untreated infection, blue-gray patches appear on the overlying skin after 36 hours, and cutaneous bullae and
necrosis develop after 3 to 5 days.
In some patients who remain untreated, a sign of improvement is the decrease in the pain of the affected area.
The mortality rate among patients who do not undergo surgical intervention approaches 50%.

4.

Pregnant women can safely receive vaccinations for the following (HPIM 16th ed, p. 720):
A. Tetanus
B. Measles
C. Rubella
D. Mumps
E. Diphtheria

5.

The following regimen/s can be used in the treatment of enterococcal infective endocarditis (HPIM 16th ed, p. 736 737):
A. Penicillin G 3-4 million units IV q4 plus Gentamicin 1 mg/kg IV q8, both for 4 6 weeks
B. Ceftriaxone 2 g/d IV as single dose for 4 weeks
C. Penicillin G 2 -3 million units IV q4 for 4 weeks
D. Ampicillin 2 g IV q4 plus Gentamicin 1 mg/kg IV q8, both for 4 6 weeks
E. Vancomycin 15 mg/kg IV q12 for 4 6 weeks

6.

In the treatment of infective endocarditis before culture results are known or when cultures are negative, the following
principle/s should be considered (HPIM 16th ed, p. 737):
A. Emprical therapy for acute endocarditis in an injection drug user should cover for methicillin-resistant S. aureus
and gram-negative bacilli.
B. In the absence of confounding prior antibiotic therapy, the most common organisms presenting with negative
blood cultures include coagulase-negative staphylococci and enterococci.
C. Marantic endocarditis should be excluded in culture-negative endocarditis.
D. Blood-culture negative subacute native valve endocarditis is empirically treated with Ampicillin plus Gentamicin.
E. Blood culture negative prosthetic valve endocarditis may be empirically treated with Vancomycin alone.

7.

The following skin lesions is/are appropriately matched with their causative organisms: (HPIM 16 th ed, p. 742):

A.
B.
C.
D.
E.

Impetigo contagiosa Streptococcus pyogenes

Bullous impetigo Staphylococcus aureus
Hot-tub folliculitis Pseudomonas aeruginosa
Erysipelas Staphylococcus aureus
Ecthyema gangrenosum Pseudomonas aeruginosa

8.

Mr. X is a 56 year old diabetic male who was admitted at the Emergency Room due a 1-month history of non-healing
wound in his left foot. During examination of the base of the necrotic are with a blunt surgical probe, bone was palpable.
The following statement/s is/are TRUE. (HPIM 16th ed, p. 746)
A. These infections are mostly polymicrobial and are more likely to involve gram-negative and anaerobic bacteria.
B. Contiguous-focus osteomyelitis is likely in this patient.
C. Generalized vascular insufficiency predispose Mr. X to osteomyelitis.
D. Chronic osteomyelitis is more likely to develop in hematogenous osteomyelitis than in contiguous-focus
osteomyelitis.
E. Chronic osteomyelitis may lead to squamous cell carcinoma of the sinus tract.

9.

J.A. is a 28 year old female, a chronic alcoholic, known to have liver cirrhosis since 1 year ago. Three days prior to
consult, she developed moderate grade fever, associated with decreased appetite and malaise. There was no abdominal
pain, cough, or dysuria. On physical examination, she had ascites, with abdominal tenderness on deep palpation of all
abdominal quadrants. The following statement/s is/are TRUE about this condition. (HPIM 16 th, p. 750)
A. The most common manifestation is fever.
B. According to Conn, the finding of >250 lymphocytes per microliter of ascitic fluid is diagnostic for this disease.

C.
D.
E.

While enteric gram-negative bacilli such as Escherichia coli are most frequently encountered, anaerobes are
also often found.
Third generation cephalosporins such as cefotaxime provide reasonable initial coverage in moderately ill
patients.
Antibiotics can be administered for as little as 5 days if rapid improvement occurs and blood cultures are
negative.

10. Abscess formation is common in untreated peritonitis. The following statement/s is/are TRUE regarding the pathogenesis
and clinical presentation of peritoneal abscesses. (HPIM, p. 751)
A. IL-10 prevents abscess formation by downregulating the inflammatory response.
B. Visceral abscesses are much more common than intraperitoneal or retroperitoneal abscesses.
C. Diverticular abscesses are least likely to rupture.

D.
E.

When abscesses occur in the female genital tract, a common isolate is Bacteroides fragilis.
Most visceral abscesses result from fecal spillage from a colonic source, such as an inflamed appendix.

11. The following microorganisms cause non-inflammatory diarrhea via the production of enterotoxins (HPIM 16 th ed, p. 755):
A. Vibrio cholera
B. Salmonella typhi
C. Shigella spp.
D. Clostridium perfringens
e.
Staphylococcus aureus
12. The following antibiotics have been found to cause Clostridium-difficile associated disease (CDAD) (HPIM, 16 th ed., p.
760):
A. Clindamycin
B. Ampicillin
C. Piperacillin-Tazobactam
D. Vancomycin
E. Metronidazole
13. The diagnosis of Clostridium difficile associated disease is based on the presence of diarrhea with no recognized cause
plus any of the following (HPIM 16th ed, p. 761):
A. Toxin A detected in stool
B. Toxin B detected in stool
C. Clostridium difficile detected by stool culture
D. Pseudomembranes seen on passed out stool
E. Pseudomembranes seen in the colon on colonoscopy
14. In the treatment of women with abnormal vaginal discharge, the following statement/s is/are TRUE (HPIM, 16 th ed, p. 766
767):
A. In developing countries, oral treatment with a 2 gram single dose or a 7-day regimen of Metronidazole provides
reasonable coverage against both trichomoniasis and bacterial vaginosis.
B. Treatment of sex partners with metronidazole helps prevent the recurrence of bacterial vaginosis.
C. Systemic use of metronidazole is not advisable during the entire duration of pregnancy.
D. The standard dosage of metronidazole for the treatment of bacterial vaginosis is 500 mg orally BID for 7 days.
E. Long-term recurrence of bacterial vaginosis is common with either oral or intravaginal clindamycin therapy.
15. The following statement/s is/are TRUE about pelvic inflammatory disease (PID) (HPIM 16 th ed, p. 769):
A. The use of an intrauterine contraceptive device may increase a womans risk for PID.
B. Women on oral contraceptives appear to have increased risk for symptomatic PID.
C. Tubal ligation also increases the risk for salpingitis due to the resulting impairment of tubal peristaltic
movements.
D. Repeated exposure to Chlamydia trachomatis leads to the greatest degree of tissue inflammation and damage.
E. PID associated with Neisseria gonorrhea and Chlamydia trachomatis often occurs during or soon after the
menstrual period.
16. In the management if patients presenting with genital ulcerations, the following statement/s is/are TRUE (HPIM 16 th ed, p.
772):
A. Clinicians should order a rapid serologic test for syphilis 9in all patients presenting with genital ulcers.
B. Typical vesicles or pustules or painful vesiculopapular lesions are suggestive of primary syphilis.
C. If inguinal lymphadenopathy with fluctuance or overlying erythema is noted along with painful and purulent
ulcers, demonstration of H. ducreyi by culture is useful.
D. Patients with chronic, persistent genital herpes should undergo HIV screening.
E. A positive test for HSV-2 antibody proves that the current genital lesions are herpetic.
17. Your clerk asks you about nosocomial urinary tract infections. You tell him the following (HPIM 16 th ed., p. 777):
A. The most common cause is the intraluminal contamination of urinary catheters due to caregivers who do not
practice hand hygiene.
B. Irrigation of catheters, especially with antimicrobials, reduces the risk of nosocomial UTI.
C. Using a condom catheter instead of a foley catheter in males substantially decreases the risk for nosocomial
UTI.
D. Almost all nosocomial UTIs are preceded by urinary tract instrumentation or the use of indwelling bladder
catheters.
E. The most common pathogens involved in nosocomial UTI are E. coli, nosocomial gram-negative bacilli, and
MRSA.
18. The following subset/s of patients is/are at risk for Staphylococcus aureus infection (HPIM, 16th ed, p. 816):
A. Patients with diabetes
B. Patients with functional and anatomic asplenia
C. Patients with HIV
D. Patients with chronic granulomatous disease
E. Patients with IgA deficiency
19. In the treatment if Staphylococcal infections, the following statement/s is/are TRUE (HPIM 16 th ed, p. 821):

A.
B.
C.

D.
E.

Treatment for Staphylococcus aureus bacteremia is generally prolonged (4 to 8 weeks), due to its many wellrecognized complications.
Patients with persistently positive blood cultures after 24 hours of antibiotics are at increased risk of complicated
bacteremia.
Second and third generation cephalosporins have a therapeutic advantage over first-generation cephalosporins
in the treatment of staphylococcal infections.
The crabapenems should be reserved for methicillin-resistant Staph. aureus infections.
Vancomycin is the drug of choice for the treatment of methicillin-resistant staphylococcal infections.

20. A 22 year old female consulted you for throat pain, fever and chills of 2 days duration. On PE, you observed erythema and
swelling of the pharyngeal mucosa and purulent exudates over the posterior pharyngeal wall. The following statement/s
is/are TRUE (HPIM 16th ed, p. 824 825):
A. The etiology is likely to be viral if the patient also complains of prominent conjunctivitis, coryza and hoarseness.
B. If this is streptococcal pharyngitis, symptoms are expected to resolve after 3 to 5 days.
C. To prevent rheumatic fever, penicillin should be given until the symptoms completely resolve.
D. The patient may spread the infection through respiratory droplets, but not through food-borne routes.
E. Treatment with penicillin would reduce the likelihood of acute rheumatic fever and post-streptococcal
glomerulonephritis.

21. A 32 year old male was admitted at the ER for trismus. He had a history of tooth extraction in a dental mission 3 days
before. On your PE, he had risus sardonicus, increased jaw muscle tone, spasms of his upper back muscles, though he
was still able to walk around comfortably and was still conversant. The following statement/s about the patients condition
is/are TRUE. (HPIM 16th ed, p. 841)
A. Immediate referral to ENT for tracheostomy should be made even if patient is still comfortable.
B. The use of Metronidazole or Penicillin has been proven by randomized controlled trials to eradicate vegetative
organisms.
C. The patient should be given at least 3000 to 6000 units IM of Human Tetanus Immune Globulin.
D. Large doses of diazepam should be avoided because of its antagonistic effects on GABA.
E. Should the patient recover, active immunization is no longer necessary because he is expected to develop
immunity from his having the disease.
22. A 50 year old male was admitted at the ER for a 1-day history of fever, petechial skin lesions, headache, lethargy, and
confusion. You received him obtunded and hypotensive. Gram stain of his CSF shows gram-negative diplococci. The
following statement/s is/are TRUE about this patients illness: (HPIM, 16th ed. 853)
A. If the CSF does not show leukocytosis, the prognosis for normal recovery is often better than if leukocytosis
was present.
B. Normal blood leukocyte count is associated with better chances for recovery.
C. The absence of meningitis is also a good prognostic factor.
D. A third-generation cephalosporin such as cefotaxime or ceftriaxone is preferred for initial therapy.
E. Patients with meningococcal meningitis should be given antimicrobial therapy for at least 4 weeks.

23. You were the SHO when the patient in the previous item was admitted. You then mobilize hospital resources for the
provision of ciprofloxacin as chemoprophylaxis to individuals or groups at risk. The following should receive
chemoprophylaxis (HPIM 16th ed, p. 854):
A.
Janitors and security guards stationed at the ACU during the patients admission.
B.
The treatment officer who intubated the patient.
C.
The ER nurse in charge of suctioning the patients secretions.
D.
The surgeon-on-duty who was suturing a mauling victim at the surgery treatment area when the patient was
wheeled into the resuscitation area.
E.
The intern who extracted blood and handled the patients ETA gs/cs specimens.
24. The following statement/s is/are TRUE about gonorrhea (HPIM 16th ed., p. 855 857):
A.
It is transmitted more efficiently from males to females than vice versa.
B.
Males often acquire the oropharyngeal gonorrhea by cunnilingus while females do not acquire it by fellatio.
C.
Gonococcal infection must be ruled out by culture in every case of conjunctivitis in infants.
D.
Ocular gonorrhea in an adult usually results from inoculation of organisms into the patients eyes from an
infected partners genitals.
E.
Gonococcal isolates from the rectum of homosexual men tend to be more resistant to antimicrobials compared
with other gonococcal isolates.
25. Your 35 year old friend recently arrived from a 2 week business trip to Cebu where he admitted to feast on talaba and
Cebu street food. On his arrival, he consulted you for a 4-day history of fever, chills, anorexia, headache, loose stools, and
vague abdominal discomfort. On examination, he was febrile at 38.5C, with BP 140/90, HR 72, RR 20. He had no
jaundice, conjunctival suffusion, rashes, nor abdominal tenderness. The following statement/s is/are TRUE about your
friends condition (HPIM 16th ed., p. 898 899):
A. While your friends illness can result from ingestion of contaminated food or water, the more common mode of
transmission is the fecal-oral route.
B. The most prominent symptom if this systemic infection is abdominal pain.

C.
D.
E.

Your friends blood cultures may give a positive yield of as high as 90% if you obtain them after the 3 rd week of his
illness.
Bone marrow cultures remain highly sensitive even if your friend has been on antibiotics for 5 days.
Upon your friends consult, you should already recommend stool cultures as they will be positive in 60 to 70% if
cases.

26. After giving your friend in #25 appropriate antibiotic therapy, you recommended vaccination against typhoid fever because
of his terrible street food habits. He refuses vaccination, however. Humiliated, you checked the recommendations of the
Center for Disease Control and found out that the only recommendations for domestic vaccination is/are the following:
(HPIM 16th ed., p. 900):
A.
Food handlers
B.
Physicians and health professionals
C.
Veterinarians
D.
Intimate contacts of a chronic carrier
E.
Laboratory professionals working with S. typhi
27. You attempt to be adventurous and do some backpacking on your own to the hinterlands of Maguindanao. Two days into
your trip, you suddenly had voluminous, non-bloody, watery diarrhea, occurring almost 10 times within 2 hours. You had
no fever but you felt dry and very weak. The following statement/s is/are TRUE about your illness. (HPIM 16 th ed, 911)
A. Susceptibility to the causative organism is influenced by ABO blood group status, with Type O having the greatest
risk and Type AB having the least risk.
B. This illness is a toxin-mediated disease.
C. The amount of Na+ in oral rehydration fluids used in the treatment of this illness is higher than that used to treat
diarrhea due to most other causes.
D. In severely dehydrated patients, intravenous potassium is preferred over oral supplementation and should be
started along with IV fluids.
E. Antibiotics such as tetracycline and doxycycline are necessary for cure.
28. The following statement/s about aspiration pneumonia and/or pneumonitis is/are TRUE (HPIM 16th ed., p. 942):
A. In Mendelsons Syndrome, antibiotic therapy is not indicated unless bacterial infection supervenes.
B. Typically, Mendelsons Syndrome develops within minutes after anesthesia induction when the patient suddenly
becomes hypotensive and highly febrile.
C. Foul-smelling sputum indicates that aspiration pneumonia has been ongoing for at least a month.
D. If the patient aspirated on the upright position, chest xray will characteristically show consolidation of the basilar
segments of the lower lobes.
E. Gram staining of sputum of patients with aspiration pneumonia usually shows mixed bacterial flora with many
neutrophils.
29. In the evaluation of patients with suspected anaerobic infections, specimens must be collected by meticulous sampling of
the infected sites. The following is/are acceptable specimens that can be cultured for anaerobes (HPIM 16 th ed., p. 944):
A.
Bronchoscopy washings
B.
Vaginal vault swabs
C.
Pus aspirated from an abscess cavity
D.
Midstream, clean-catch urine
E.
Cerebrospinal fluid
30. Included among the drugs referred to as first-line essential antituberculous agents are the following (HPIM 16 th ed., p.
946):
A.
Rifampicin
B.
Isoniazid
C.
Pyrazinamide
D.
Ethambutol
E.
Streptomycin
31. The following statement/s is/are TRUE about tuberculosis (HPIM 16th ed., p. 955):
A. Those with extrapulmonary tuberculosis are essentially non-infectious.
B. The risk of acquiring tuberculosis infection depends mainly on exogenous factors.
C. The risk of acquiring disease from tuberculosis is determined largely by endogenous factors.
D. In high-prevalence areas, up to 50 contacts are infected by each sputum AFB positive individual.
E. The most potent risk factor for tuberculosis among infected individuals is diabetes, due to impairment of cellular
immunity.
32. A 62 year old male presented with chronic cough, anorexia, and a millet seed pattern of reticulonodular infiltrates on chest
radiograph. The following statement/s is/are TRUE about this condition (HPIM 16 th ed., p. 959):
A. His sputum AFB smear will most likely be positive.
B. The PPD test may be negative in up to half of patients with similar illness.
C. This disease is due to the hematogenous spread of the tubercle bacilli.
D. The chest x-ray may be normal among HIV-infected patients.
E. To reveal the pathognomomnic finding in this case, a meticulous eye examination should be undertaken.

33. Although the transmission of leprosy remains uncertain, the following are the most accepted routes (HPIM 16 th ed., p.
967):
A.
Nasal droplet infection
B.
Contact with infected soil
C.
Skin-to-skin contact
D.
Fecal-oral route
E.
Insect vectors

iii.

34. The following features favor a diagnosis of lepromatous leprosy over a tuberculoid type (HPIM, p. 968):
A.
Hypopigmented macules plaques that are sharply demarcated and hypesthetic
B.
A 2:1 predominance of CD8+ to CD4+ T lymphocytes in tissues
TH2 cytokine profile rich in IL-4, IL-5 and IL-10
D.
Positive lepromin skin tests
E.
Symmetrically distributed skin nodules or diffuse dermal infiltration
35. Lepra reactions comprise several common immunologically mediated inflammatory states that cause considerable
morbidity. The following statement/s is/are TRUE about these reactions (HPIM 16th ed., p. 968):
A. Type 1 Lepra reactions occur in patients with borderline leprosy but not in patients with polar disease.
B. The most common nerve involved in Type 1 Lepra reactions is the peroneal nerve, resulting in footdrop.
C. Type 1 Lepra reactions are also known as Erythema Nodosum Leproticum.
D. The most common features of Type 2 Lepra reactions are painful, erythematous papules that resolve
spontaneously but may recur, along with fever and malaise.
E. Skin biopsy of Type 2 Lepra reactions characteristically reveals tissue edema.
36. In the evaluation of patients with syphilis, the following statement/s are TRUE (HPIM 16 th ed., p. 979 981):
A. A patient with a positive serologic test for syphilis, with no clinical manifestations but with mononuclear
pleocytosis on CSF examination is said to have latent syphilis.
B. Secondary syphilis may present as an acute nephrotic syndrome.
C. Circumferential calcification of the ascending aorta on chest xray suggests syphilitic aortitis.
D. Condyloma lata occurs in 10% of patients with primary syphilis.
E. The pathogenesis of congenital syphilis suggests that the effect of the disease on the fetus depends on the
immune response of the host rather than on a direct toxic effect of the organism.
37. There are two types of serologic test for syphilis. The following statement/s is/are TRUE about these tests: (HPIM 16th ed.,
p. 982-983)
A. Both types of test are also reactive for patients with yaws, pinta and endemic syphilis.
B. The RPR and VDRL tests are both nontreponemal tests that measure IgG and IgM directed against a
cardiolipin-lecithin-cholesterol antigen complex.
C. While the VDRL test is preferred in the office or clinic setting, the RPR test is the standard test for use with CSF.
D. All treponemal and nontreponemal tests are reactive during secondary syphilis and a nonreactive result virtually
excludes syphilis in a patient with otherwise-compatible mucocutaneous lesions.
E. Treponemal tests are helpful in determining the infection status of persons with past syphilis because they will
become non-reactive after treatment.
38. The following is/are condition/s listed in the AIDS surveillance case definition (Category C of HIV infection) (HPIM 16 th ed.,
p. 1076):
A. Oropharyngeal candidiasis
B. Invasive cervical cancer
C. Burkitts Lymphoma
D. Idiopathic Thrombocytopenic Purpura
E. Kaposis Sarcoma
39. The following statement/s is/are TRUE regarding the transmission of HIV (HPIM 16th ed., p. 1079 1080):
A. The most common mode of infection worldwide is homosexual (male-to-male) transmission.
B. Male-to-female transmission is far more efficient than female-to-male transmission.
C. Skin popping and muscling during injection drug use are considered lowrisk practices and are not known
to transmit HIV.
D. Hepatitis B immune globulin, plasma-derived Hepatitis B vaccine, and Rho immune globulin have all been
associated with transmission of HIV.
E. Maternal transmission of HIV to the fetus occurs most commonly during the first and second trimesters of
pregnancy.
40. Aberrant immune activation is the hallmark of HIV infection and is a critical component of the pathogenesis of HIV
disease. The following statement/s support/s this (HPIM 16th ed., p. 1091):
A. There is lymph node hyperplasia particularly early in the course of the disease.
B. Due to this immune system hyperactivity, there is depletion of B cells and resulting hypogammaglobulinemia.
C. Coinfection with other viruses such as CMV, EBV and HTLV-I can upregulate HIV expression.
D. Infestation of nematodes has been found to downregulate HIV replication.
E. HIV predisposes an individual to develop active TB while active TB accelerates the course of HIV infection.
41. In the diagnosis of HIV infection, the following statement/s is/are TRUE (HPIM 16th ed., p. 1100 1101):
A. Among those who test positive during standard HIV screening, only 10% of them are subsequently confirmed to
have HIV infection.
B. The presence of renal disease, acute viral infections and recent pneumococcal vaccination may give a falsepositive HIV screening test.
C. According to the US FDA, western blot is considered positive if antibodies exist for any one of the following HIV
proteins: p24, gp41, gp120/160.
D. If the result of ELISA is negative, retesting should always be performed as ELISA has a high false-negativity
rate.
E. If the western blot is positive, the diagnosis is HIV-1 infection.
42. Which among the following are components of Weils Syndrome (HPIM 16th ed., p. 988)?
A. Jaundice
B. Conjunctival suffusion
C. Renal dysfunction
D. Hemorrhagic diathesis
E. Calf tenderness
43. In milder cases of leptospirosis, the following oral antibiotics can be given (HPIM 16th ed., p. 991):
A. Tetracycline
B. Doxycycline
C. Ampicillin
D. Amoxicillin
E. Clindamycin
44. A 45 year old male was admitted at the ER for sudden combativeness, agitation, muscle spasms, and hydrophobia. Upon
arrival at the ER, he was having opisthotonic posturing and was foaming at the mouth. He had a history of a cat-bite 1
week prior. The following statement/s is/are TRUE of this patients illness (HPIM, 16th ed., p. 1157):

A.
B.
C.
D.
E.

The prodromal period of this illness usually lasts 1 to 4 days.

The presence of paresthesias and/or fasciculations at or around the site of the cat bite is a prodromal symptom
of this disease.
Majority of these patients will demonstrate Negri bodies on pathologic examination of the brain, such that their
absence would rule out the diagnosis.
The manifestations of brainstem dysfunction begin shortly after the onset of the encephalitic phase.
There is no specific treatment for this patients illness.

45. The following statement/s is/are TRUE about dengue fever (HPIM 16th ed., p. 1164):
A. There are 6 distinct dengue viruses and all of them have Brugia malayi as their principal vector.
B. The mosquito vector for dengue usually inhabits fresh water stored in dwellings and frequently bites during
evenings.
C. This disease was given the colloquial designation of breakwater fever.
D. There is often a macular rash on the first day of illness accompanied by lymphadenopathy, palatal vesicles, and
scleral injection.
E. During defervescence, a maculopapular rash beginning on the trunk and spreading to the extremities and face
may appear.
46. Several factors affect the susceptibility to dengue hemorrhagic fever or dengue shock syndrome (DHF/DSS). The
following statement/s is/are TRUE (HPIM 16th ed, 1173):
A. Susceptibility to DHF/DSS increases considerably after 12 years of age.
B. Females are more affected than males.
C. Caucasians are the least susceptible race.
D. Malnutrition is protective.
E. Type 2 serotype is apparently more dangerous than the other serotypes.
47. The following statement/s is/are true about Severe Acute Respiratory Syndrome (SARS): (HPIM 16th ed., 1061-1062):
A. The causative agent is a coronavirus.
B. Clustering of cases in Hong Kong suggests that the virus can be transmitted via the fecal-oral route as well.
C. Approximately 25% of SARS patients also have diarrhea.
D. Chest x-rays characteristically shows central distribution of alveolar infiltrates resembling that of pulmonary
edema.
E. SARS infection appears to be milder in children than in adults.
48. The following is/are known reservoirs of the varicella-zoster virus that causes chickenpox (HPIM, p. 1042):
A. Humans
B. Primates
C. Cattle
D. Poultry
E. Canines
49. The following are drugs that can be used in the treatment of Mycobacterium avium complex (MAC) (HPIM 16 th ed., p.
975):
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Streptomycin
E. Clarithromycin
50. According to the Center for Disease Control and Prevention, the following groups should receive annual influenza
vaccination (HPIM 16th ed., p. 1070):
A. Persons age 65 or older
B. Adults and children with chronic pulmonary disease
C. Adults and children with chronic cardiovascular disease
D. Physicians (in-hospital or out-patient settings)
E. Household members of persons in groups at risk
51. All the common species of Aspergillus that cause disease in humans are ubiquitous in the environment. The following
statements are TRUE about aspergillosis. (HPIM, 16th ed., p. 1188 1189):
A. Aspergillus flavus is the most common cause of aspergillosis.
B. Massive inhalation of Aspergillus spores by healthy persons can lead to acute, diffuse, self-limited pneumonitis.
C. Although aspergillomas may develop in patients with preexisting cavitary tuberculosis, tissue invasion does not
occur.
D. Even a single isolation of Aspergillus from the sputum of a neutropenic patient suggests a diagnosis of invasive
aspergillosis.
E. The repeated isolation of Aspergillus from sputum or the demonstration of hyphae in sputum of
immunocompetent individuals suggests lung invasion and should prompt bronchoscopy.
52. Most cases of hand-foot-and-mouth disease are due to the following virus/es: (HPIM 16 th ed., p. 1146)
A. Echovirus 6
B. Echovirus 9
C. Enterovirus 71
D. Coxsackievirus B1
E. Coxsackievirus A16
53. These clinical conditions fall under the classification of viral hemorrhagic syndromes (HPIM 16 th ed., p. 1169 1170):
A. Lassa Fever
B. West Nile Virus Infection
C. Chikungunya Virus Infection
D. Hantavirus Pulmonary Syndrome
E. Yellow Fever
54. This/these antimicrobial/s exert its/their effect by binding to the 30s subunit of the bacterial ribosome disrupting protein
synthesis: (HPIM 16th ed., p. 790)
A. Beta lactams
B. Lincosamides
C. Tetracycline
D. Aminoglycosides
E. Macrolides
55. These genetic disorders confer protection against death from falciparum malaria: (HPIM 16th ed., p. 1221):
A. Sickle cell disease
B. Paroxysmal Nocturnal Hemoglobinuria
C. Thalassemia
D. Aplastic Anemia
E. G6PD Deficiency
56. Chronic or repeated malarial infections may result in the following conditions: (HPIM 16th ed., 1223 1225):

A.
B.
C.
D.
E.

Splenomegaly
Burkitts Lymphoma
Sickle Cell Disease
Recurrent hypoglycemia
Nephrotic syndrome

57. Which of the following species of schistosoma have sexually mature worms that preferentially reside in the intestinal veins
(HPIM 16th ed., p. 1266)?
A. S. mansonii
B. S. japonicum
C. S. mekongi
D. S. intercalatum
E. S. hematobium
58. The following parasite/s has/have been epidemiologically related to cause cholangiocarcinoma in China and Thailand:
(HPIM 16th ed., p. 1271)
A. Fasciola hepatica
B. Fasciola gigantica
C. Opisthotorchis viverinni
D. Opisthotorchis felineus
E. Chlonorchis sinensis
59. The pilot episode of House, MD featured a teacher with neurocysticercosis. Your non-doctor friends ask you about the
facts and fallacies presented in this episode. The following statements are TRUE about this disease (HPIM 16 th ed., 1773
1275):
A. The causative organism is a cestode which may be several meters long.
B. The adult organism resides in the duodenum where it may live for years.
C. Neuroimaging findings include cystic lesions with or without ring enhancement, one or more nodular
calcifications, or focal enhancing lesions.
D. CSF pleocytosis with a predominance of lymphocytes, neutrophils, or eosinophils is pathognomonic for
nuerocysticercosis.
E. Treatment with praziquantel or albendazole may exacerbate seizures or hydrocephalus.
60. Protozoan intestinal infections are among the most common parasitic diseases worldwide. The following statements are
TRUE regarding these infections (HPIM 16th ed., p. 1248 1250):
A. Giardia is a cosmopolitan protozoal parasite that inhabits and excysts in the large intestine but does not
disseminate hematogenously.
B. Infection in humans requires ingestion of a considerable number of cysts and person-to-person transmission
occurs when fecal hygiene is poor.
C. Metronidazole 250 mg thrice daily for 5 days is highly effective for giardiasis.
D. Cryptosporidium does not cause disease in both immunocompetent and HIV-infected individuals.
E. Eradication of cryptosporidium has been achieved with trimethoprim-sulfamethoxazole.
PART 2. MULTIPLE CHOICE. Choose the BEST answer.
1.

Among the elderly, what is the most frequent cause of fever of unknown origin (FUO)? (HPIM, p. 117)
A.
Multisystem disease such as giant cell arteritis
B.
Infections such as tuberculosis
C.
Malignancies such as colon CA
D.
Granulomatous diseases such as sarcoidosis
E.
Factitious fever due to depression

2.

What is the most common site of acute hematogenous osteomyelitis in adults? (HPIM, p. 746)
A.
Tibia
B.
Femur
C.
Humerus
D.
Vertebral bodies
E.
Pelvis

3.

What is said to be the most pathogenic non-tuberculous mycobacterial species affecting the lung? (p. 975)
A.
Mycobacterium avium
B.
Mycobacterium kansaii
C.
Mycobacterium abscessus
D.
Mycobacterium chelonae
E.
Mycobacterium fortuitum

4.

What is the earliest sign of congenital syphilis?

A.
rhinitis
B.
mucocutaneous lesions
C.
hepatosplenomegaly
D.
osteochondritis
E.
leukocytosis

5.

What is the most benign among the treponemal infections?

A.
Yaws
B.
Endemic syphilis
C.
Pinta
D.
Leptospirosis
E.
Veneral syphilis

6.

In patients with Staphylococcus aureus endocarditis, B-lactam therapy can result in sterile blood cultures after how many
days of therapy? (p.738)
A.
2 days
B.
3 to 5 days
C.
7 to 9 days
D.
10 days
E.
14 days

7.

Sinusitis is very common during all stages of HIV infection. What sinuses are most commonly involved? (p. 1105)
A.
Maxillary
B.
Ethmoid
C.
Sphenoid
D.
Frontal
E.
Pyriform

8.

Although most autoimmune diseases are somewhat ameliorated by the concomitant presence of HIV infection, which
autoimmune disease appears to have increased frequency in HIV patients? (p. 1113)
A.
Systemic lupus erythematosus
B.
Rheumatoid arthritis

C.
D.
E.

Primary Sjogrens Syndrome

Myasthenia gravis
Scleroderma

9.

What enterovirus is the most common cause of rubelliform rash? (p. 1145)
A.
Echovirus 18
B.
Echovirus 9
C.
Echovirus 6
D.
Coxsackievirus B5
E.
Coxsackievirus B2
10. The most common cause of viral upper respiratory infections: (HPIM, p. 185):
A.
Rhinovirus
B.
Influenza virus
C.
Coronavirus
D.
Adenovirus
E.
Respiratory syncytial virus
11. What is the single most reliable laboratory finding among patients with hepatic abscesses? (HPIM 16 th ed., p. 752)
A.
Leukocytosis
B.
Hypoalbuminemia
C.
Anemia
D.
Hyperbilirubinemia
E.
Elevated alkaline phosphatase
12. What is the most important risk factor for the development if perinephric abscesses (HPIM, 16 th ed., p. 754):
A.
History of urologic manipulation
B.
Presence of nephrolithiasis
C.
Trauma
D.
Presence of reflux nephropathy
E.
Diabetes mellitus
13. What is considered as the most important and the most potent antituberculous agent available? (HPIM 16th ed., p. 946)
A.
Rifampicin
B.
Isoniazid
C.
Pyrazinamide
D.
Ethambutol
E.
Streptomycin
14. Among established agents used in the treatment of leprosy, which among the following is/are bactericidal?
A.
The one that is contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency
B.
The one that causes orange discoloration of body fluids
C.
The one that causes red-black skin discoloration
D.
Both A and B
E.
Both A and C
15. Which of the following is accepted as the best indicator of the immediate state of immunologic competence of a patient
with HIV infection? (HPIM 16th ed., p. 1103)
A.
CD4+ T-cell count
B.
CD8+ T-cell count
C.
HIV DNA levels
D.
HIV RNA levels
E.
p24 antigen assay
16. What is the hallmark of HIV-associated nephropathy? (HPIM 16th ed., p. 1111)
A.
Edema
B.
Hypertension
C.
Proteinuria
D.
Enlarged, hyperechogenic kidneys
E.
Hematuria
17. What is the drug of choice for the prophylaxis of pneumocystosis? (HPIM 16th ed., p. 1196)
A.
Dapsone
B.
Pentamidine
C.
Atovaquone
D.
Trimethoprim-sulfamethoxazole
E.
Clindaycin plus Primaquine
18. What is the leading cause of severe childhood gastroenteritis worldwide and is more frequently associated with
dehydration than is gastroenteritis caused by any other pathogen? (HPIM 16 th ed., p. 1141 1142)
A.
Norwalk virus
B.
Rotavirus
C.
Echovirus
D.
Enteric adenovirus
E.
Astrovirus
19. For schistosomiasis endemic in the Philippines, how should drug therapy be administered to adults? (HPIM 16 th ed., p.
1271)
A.
Praziquantel 20 mg/kg, 2 doses in 1 day
B.
Praziquantel 20 mg/kg, 3 doses in 1 day
C.
Praziquantel 10 mg/kg/ day for 7 days
D.
Praziquantel 10 mg/kg as single dose
E.
Triclabendazole 10 mg/kg once
20. What is the largest intestinal nematode parasite found in humans? (HPIM 16 th ed., p. 1257)
A.
Ascaris lumbricoides
B.
Ancyclostoma duodenale
C.
Necator americanus
D.
Taenia solium
E.
Taenia saginata
21. What antimalarial drug has been shown to be active against hypnozoites? (HPIM 16th ed., p. 1288 1289)
A.
Quinine
B.
Chloroquine
C.
Primaquine
D.
Artemisinin
E.
Atovaquone
22. What is the drug of choice for lymphatic filariasis? (HPIM 16th ed., p. 1262)
A.
Albendazole

B.
C.
D.
E.

Diethylcarbamazine
Praziquantel
Ivermectin
Mebendazole

23. Which of the following is responsible for the disease known as kala-azar? (HPIM 16th ed., p. 1235)
A.
Babesia microti
B.
Trypanosoma cruzi
C.
Naegleria fowleri
D.
Treponema pallidum
E.
Leishmania donovani
24. A patient was admitted for fever and jaundice after wading in floodwaters. He was noted to have calf conjunctival suffusion
and calf tenderness. When is renal failure expected to happen if this becomes a complicated case? (HPIM 16th ed., p.
989)
A.
Onset of illness

B.
C.
D.
E.

Within the 1st week of illness

On the second week of illness
On the third week of illness
After 1 month of illness

25. What type of influenza causes the most extensive and severe outbreaks? (HPIM 16th ed., p. 1066)
A.
Influenza A
B.
Influenza B
C.
Influenza C
D.
Influenza D
E.
Influenza E
26. What occupation predisposes patients to develop of Japanese Encephalitis? (HPIM 16th ed., p. 1166)
A.
Fisherman
B.
Physician
C.
Veterinarian
D.
Meat Handler
E.
Farmer
27. If I am a dog, where should I bite the man to increase his chance of getting and dying from rabies? (HPIM 16th ed., p,
1157)
A.
Hand
B.
Arm
C.
Leg
D.
Face
E.
Foot
28. What is the most common cause of transient aplastic crisis in patients with chronic hemolytic disease? (HPIM 16 th ed., p.
1055)
A.
Poxvirus B23
B.
Parvovirus B19
C.
HPV 6
D.
HPV 11
E.
Echovirus 21
29. What is the most common presentation of Parvovirus B19 infection among adults?
A.
Aplastic anemia
B.
Abdominal pain
C.
Nephrotic syndrome
D.
Arthralgias and arthritis
E.
Cough
30. Which among the following Human Papillomaviruses are not considered as a high-risk or oncogenic type? (HPIM 16th ed.,
p. 1057)
A.
Type 11
B.
Type 16
C.
Type 18
D.
Type 31
E.
Type 35
31. Ophthalmologic problems occur in half of patients with advanced HIV infection. What is the most common abnormal
finding on funduscopic examination? (HPIM 16th ed., p. 1119)
A.
Perivascular hemorrhages
B.
Arteriolar nicking
C.
Necrotizing retinitis
D.
Cotton-wool spots
E.
Neovascularization
32. What is the most severe complication of influenza? (HPIM 16th ed., p. 1068 -1069)
A.
Myositis
B.
Subacute Sclerosing Panencephalitis
C.
Secondary bacterial pneumonia
D.
Renal failure
E.
Reyes Syndrome
33. What is the characteristic feature that helps distinguish filarial lymphangitis from typically ascending bacterial
lymphangitis? (HPIM 16th ed., p. 1262)
A.
Concomitant thrombophlebitis
B.
Associated bacterial infection
C.
Non-pitting edema
D.
Presence of ulcerations
E.
Retrogradely evolving lymphangitis
34. A modified bacterial toxin that has been made nontoxic but retains the capacity to stimulate the formation of antitoxin is
called (HPIM 16th ed., p. 714):
A.
Vaccine
B.
Toxin
C.
Toxoid
D.
Antitoxin
E.
Antigen
35. Which of the following vaccines is composed of a live virus? (HPIM 16th ed., p. 717)

A.
B.
C.
D.
E.

Varicella
Influenza
Pneumococci
Diphtheria and tetanus
BCG

36. A 29 year old female patient was complaining of a 4 week history of fever, and a 3 day history of jaundice and abdominal
pain and prostration. On abdominal ultrasound, the spleen was enlarged, with multiple hypoechoic foci. What is the next
step in the evaluation of this patient? (HPIM 16th ed., p. 753)
A. Do an abdominal CT scan
B. Do ultrasound-guided biopsy of the spleen
C. Order for complete hepatitis profile
D. Order for 2D Echo with Doppler studies and blood cultures
E. Do paracentesis
37. This bacteria is the most common and a highly fatal infection encountered in asplenic individuals (HPIM 16 th ed., p. 709)
A. Haemophilus influenza
B. Klebsiella pneumoniae
C. Neisseria gonorrhea
D. Staphylococcus aureus
E. Streptococcus pneumoniae
38. This organism, a potential bioterrorism agent, caused the Black Death pandemic of the 14 th and 15th century (HPIM 16th
ed., p 1283)
A. Bacillus anthracis
B. Variola major
C. Francisella tularensis
D. Yersinia pestis
E. Clostridium botulinum
39. What do Babesia, Ehrlichia, and Lyme disease have in common? (HPIM 16th ed., p. 709)
A. They all cause hemorrhagic fever.
B. They all cause an exanthema.

C.
D.
E.

They are all transmitted by the tick Ixodes scapularis.

They all respond to penicillin.
They all cause petechial rashes.

40. What is the drug of choice in the treatment of amebic abscess? (HPIM 16th ed., p. 1217)
A. Metronidazole
B. Iodoquinol
C. Parmomycin
D. Emetine
E. Chloroquine
BONUS
1.

Al Capone (the crook), Franz Schubert (the musician), Guy de Maupassant (the writer), and Adolf Hitler (the devil); what
infectious disease did these celebrities have in common? ______________________

2.

Frederic Chopin (the pianist), Eleanor Roosevelt (the US first lady), Vivien Leigh (of Gone With the Wind fame), and
Manuel Quezon (if you dont know him, youre doomed buddy!); what did they all die of? ____________________

3.

FEEDBACK ABOUT THE DEPARTMENT PLEASE. The past 6 months have been a blur. Please tell me anything you
think about how things have been and how you would want them to be.

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