HIGH YIELD REVIEW QUESTIONS

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Familiarize Key points of: a. Give BCG to patient with HIV.
Leptospirosis b. Give DPT2 to patient who had convulsions after
Tetanus DPT
Diptheria c. Give DPT to patient with convulsions
Pertussis d. No contraindications
MDR Typhoid e. Do not give vaccine to sick child.
Poliomyelitis 13. Infectious hepatitis: Hepatitis A
Syphilis 14. Dengue virus circulating in the Philippines: Dengue 3
Schistosomiasis and 4
Trichomoniasis 15. Confirmatory test for dengue: Hemagluttination
Pregnant Cholera inhibition test
Pregnant Measles 16. Gold standard for typhoid: Blood Culture
Pregnant Varicella 17. Where can you isolate lepto in the first 10 days: CSF
Pregnant Malaria 18. Dog bite with laceration: Category 3
Typhoid Fever 19. Modern control of communicable disease: prevention/
Herpes Zoster Immunization
20. Incubation period associated with more severe
disease: shorter
Identification Etiologic Agent Drug of Choice 21. Composition of ORS based on UNICEF/WHO: glucose +
Risus sardonicus Clostridium tetani Metronidazole sodium chloride + potassium chloride + citrate
22. Natural reservoir of meningococcemia: nasopharynx
Diphtheria Corynebacterium Erythromycin 23. Recrudescence: recurrence of s/sx pf P. falciparum
diphtheriae 24. Relapse: vivax/ ovale, hypnozoites
25. Essential elements of infection: source, means of
Whooping cough Bordetella Erythromycin transmission, host
pertussis 26. Cut-off for fast breathing 2 months to 12 months:
50cpm
Kopliks Spots Rubeola (Measles Supportive 27. Rash in dengue: petechiae
virus) 28. Pathogenesis of leptospirosis: direct, nonspecific,
immunologic
Rose Spots Salmonella typhi Ciprofloxacin
IDENTIFICATION:
Dysentery Shigella Ciprofloxacin Plasma leakage: dengue fever
flexneriboydii Hydrophobia: Rabies
Washerwomans hands: Cholera
Acute Parotitis Paramyxoviridae Supportive Rice watery Stools: Cholera
Washermans Vibrio cholera Tetracycline
Calf pain: Leptospirosis
hand
Cicatrix: Pulmonary TB
Chronic form of malaria: P. vivax and P. ovale
Amoebiasis Entamoeba Metronidazole [hypnozoite]
histolytica Recrudescence of malaria: P. falciparum
DOC for pregnant woman with leptospirosis: Benzyl
Schistosomiasis Schistosoma Praziquantel Penicillin (alt: Erythromycin)
japonicum
CASE 1: Dog bite
1. Category III bite
IDENTIFICATION/ MULTIPLE CHOICE Transdermal bites or scratches, mucous membrane
1. With infection, no symptoms: CARRIER contamination with saliva (licks), exposure to rabies
2. Droplets does not travel more than: 3 FEET patient through bites, contamination of mucous
3. Aedes aegypti: membranes or open skin lesions with body fluids
a. Is primarily a night time fever (except blood or feces), handling infected carcass or
b. Transmit dengue by male and female mosquito ingestion of raw infected meat, all category II
c. Lives around human habitation exposure on head and neck areas. Eating utensils
d. All of the above and casual contact not included.
e. None of the above 2. What to give to patient now?
4. Pathogenesis of rotavirus: Flattening of the villous a. Human Rabies Immune Globulin [HRIG];
5. Usual site of neonatal tetanus: Umbilical stump 0.133cc/kg (can be delayed until day 7)
6. Leading cause of death: Sepsis b. Anti-rabies vaccine, PVRV
7. Organs most affected by schistosoma: Liver and GIT c. Tetanus toxoid
8. Pathognomonic means: characteristic of the disease d. Tetanus Immune Globulin or ATS
9. Basis of IMCI: not all but common disease that affect 3. Schedule of anti-rabies vaccine of the patient,
children intradermal, in the case, may give dates:
10. Common cause of death in children 0-5 years: a. D0: give exact date sa case. Day 0 is the day
Pneumonia of consult. Give 2 doses per ID
11. General danger signs: b. D3: give exact date, Give 2 doses per ID
a. fast breathing c. D7: give exact date , Give 2 doses per ID
b. Convulsions d. D14: give exact date, no vaccine is given
c. Fever e. D28-30: give exact date, Give 2 doses per ID
d. All
12. Which is correct? CASE 2: Malaria:

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1. Malaria: symptoms range from mild constitutional Potassium [mmol/ 20 20
symptoms to organ failure; typical paroxysm: cold L]
(chills), hot (fever spikes), and sweating stages.
2. Differential Diagnoses: Dengue Fever, Typhoid Citrate [mmol/L] 10 10
Fever, Leptospirosis ( give 2 only)
3. Diagnostic Tests: Thin and thick smear (gold Osmolarity 311 245
standard), CBC (normocytic/ normochromic anemia, [mOsml/L]
thrombocytopenia), blood chemistry (decreased
electrolytes/albumin, increased BUN/Creatinine/ Year of 1975 2004
LFTs/bilirubin) Recommendation
4. Management:
a. Specific:
IDENTIFICATION
i. First line (non-severe): CQ + SP
ii. Second line if unresponsive: AL-
artemether-lumefrantine (co- ETIOLOGIC AGENT DOC/ RECOMMENDED
artem) TREATMENT
iii. Severe: Q + T/D (quinine,
tetracycline/ doxycycline. Pneumocystis jiroveci Cotrimoxazole
Clindamycin if pregnant and pneumonia
children < 8 years old)
iv. Primaquine: P. falciparum- Schistosoma japonicum Praziquantel
prevent transmission, eradicate
extrahepatic stages Clostridium tetani Metronidazole
v. Chloroquine: P. vivax
Neisseria gonorrhea Ceftriaxone 125mg IM;
b. supportive therapy: fluids, antipyretic
Azithromycin tab single dose
CASE 3: Dehydration Toxoplasma gondii Azithromycin
1. Patient comes in with the following irritable,
sunken eyes, drinks eagerly or thirsty, skin pinch Herpes simplex Acyclovir
goes back slowly.
Diagnosis: Some dehydration Cryptococcus neoformans Itraconazole [and another
2. Basis: IMCI guidelines on dehydration. conazole]
Some dehydration- 2 or more of the ff:
o Restless, irritable HIV Zidovudine, Lamivudine
o Sunken eyes and thirsty
o Skin when pinch goes back slowly [>2 Plasmodium falcifarum Chloroquine
secs]
o Thirsty Giardia lamblia Metronidazole
3. Best fluid to give: ORS Candida albicans Fluconazole
4. Compute for fluid resuscitation: See Plan B of IMCI
Entamoeba histolytica Metronidazole
CASE 4: Dehydration
1. 6 month-old patient presents with restless and Klebsiella pneumonia 3rd Generation cephalosporin
irritability. No other symptoms. [Ceftriaxone]
2. What type of dehydration: No dehydration
3. Basis: IMCI guidelines on dehydration. Cytomegalovirus Gancyclovir
In the case, the patient presented with
restlessness and irritability. Pseudomonas aeruginosa Ceftazidime
It does not meet the criteria for some
dehydration such as 2 or more of the ff: Ascaris lumbricoides Mebendazole, Albendazole
o Restless, irritable
Hepatitis B virus Interferon-Alpha
o Sunken eyes and thirsty
o Skin when pinch goes back slowly [>2 Salmonella typhi Chloramphenicol
secs]
o Thirsty Staphylococcus aureus Cloxacillin, Oxacillin
4. Best fluid to give: Patient is 6 months, so best is
breastmilk but may also give ORS. Mycoplasma pneumonia 3rd generation
5. Compute for fluid resuscitation: See Plan A of IMCI cephalosporins [Ceftriaxone]

CASE 5: Give the contents of the WHO Old and New ORS. Trichomonas vaginalis Metronidazole

Treponema pallidum Penicillin G

Old New
Bacterides Ceftazidime
Glucose [mmol/L] 111 75
Vibrio cholera Tetracycline
Sodium [mmol/L] 90 75
MRSA Vancomycin
Chloride [mmol/ 80 65
L]

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2. _____ can produce 8,000 infectious droplet nuclei:
Mycobacterium avium Azithromycin Cough- 500-800/cough
complex Talking for three- minutes 1,800/100words
Pediculosis capitis Permethrim Yawning
Sneezing- 40,000/sneeze
Sarcoples scabei Permethrim 3. A negative pressure isolation room means that:
Air flows into the corridor from the room and is
Neisseria meningitides Penicillin G exhausted to the outside with 3 air exchanges/hr
Air flows from the corridor into the room and is
Leptospira interrogans Penicillin G exhausted to the outside with 6 air exchanges/hr
The most effective
Air flows into the corridor from the room and is
ENUMERATION droplet nuclei tend to pulled by a fan through a radiation chamber
Warning signs for dengue
have a diameter of 5 Air flows from the corridor into the room with 6 air
micron. Droplet nuclei exchanges and an ultraviolet beam is directed into
1. GI signs: are generated during
a. Bleeding mucous membranes talking, coughing and the uppermost parts of the room
b. Abdominal tenderness sneezing. One cough 4. Important in TB transmission except:
c. Persistent vomiting
can generate 3000 Multiple aerocol inocula
d. Hepatomegaly > 2 cm
droplet nuclei. Talking Separation of bed linen
for 5 minutes can
2. Fluid collection as clinically evaluated generate 3000 droplet
Large drops from respiratory secretions
3. Lethargy/ restlessness nuclei and singing can Fomites
4.
generate 3000 droplet
Lab: increase in HCT with rapid decrease innuclei in one minute.
Being out-of-doors
platelets 5. Favor progression of infection to active TB except:
Sneezing generates
Signs of Envenomation the most droplet nuclei
Malnutrition
1. Myotoxicity by far (tens of Renal failure
2. Neurotoxicity thousands), which can HIV positivity
3. Hemorrhage
spread to individuals Remaining in a room from which a person with TB
up to 10 feet away.
Signs of meningitis has stayed within thrity minutes
Classic triad: nuchal rigidity, fever, altered mental 6. Associated with onset of tuberculosis hypersensitivity in
status primary complex:
CSF analysis: Bottles 1-3
Erythema nodosum
Bottle 1: glucose and protein determination
Pleurisy with effusion
Bottle 2: total cell count and differential count
Night sweats
Bottle 3: micobiological
Nonproductive cough
Pleural fluid analysis [Bottles 1-4]:
Weight loss
AFB GS/CS, Culture and sensitivity, cell cytology, 7. ____ always suggests primary TB regardless of the lung
protein and sugar analysis field involved:
Treatment for TB meningitis:
Patchy infiltrate in the thoracic apical posterior
2HRZE, 10 HR area
o IRSEP: 5, 10, 15, 20, 25
Normal chest x-ray
Creatinine clearance computation in male: Cockcroft-Gault
Large cavities with air fluid levels
formula
Pneumonia with hilar adenopathy (The more
CrCl= (140 age) X Weight in KG / 0.72 x Crea striking finding, especially in children, is that of
If female: CrCl= [(140 age) X Weight in KG / 0.72 ipsilateral hilar and contiguous mediastinal
x Crea] x 0.85 (paratracheal) lymphadenopathy)
Weils syndrome: Kidney failure, jaundice, bleeding
Nodular infiltrates in the superior segment of the
CAP MR signs: 1-4 VS, 5 General Survey, 6-7 History, 8 lower lobe
Objective findings 8. Causes of fever in the returned traveler except:
1. RR 30/min
Dengue
2. PR 125/min
HIV
3. Temp 40C or 36C
TB (http://wwwnc.cdc.gov/travel/yellowbook/
4. SBP < 90 mmHg or DBP 60 mmHg 2014/chapter-5-post-travel-evaluation/fever-in-
5. Altered mental status of acute onset returned-travelers)
6. Suspected aspiration
Malaria
7. Unstable comorbid conditions
None
8. CXR: multilobar, pleural effusion, abscess 9. Treatment of latent TB infection is indicated for persons
Types of liver abscess: pyogenic, amoebic, fungal found to be TST positive with which of the following
MAP formula: (SBP + 2DBP) / 3 indurations after contact with an active case:
3 mm induration
1. Resistance to these drugs differentiate XDR TB from MDR
5 mm induration
TB:
10 mm induration?
Isoniazid
15 mm induration
Rifampicin 10. As a general rule and because of the dangers of active
Fluoroquinolones falciparum infection, all travelers who have visited a malaria-
Pyrazinamide endemic area during the period of ___ prior to the onset of
Aminoglycoside fever or other suggestive symptoms should be considered to
A, C have malaria until proven otherwise:
B, D
7 days (IP: 7-30 days, longer incubation with P.
C, E malariae)
A, B, C
1 month
C, D, E
2 months

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3 months Interleukin-1 production in the CNS
11. Treatment for uncomplicated Chloroquine-resistant P. Differences in host immune responses
falciparum or P. vivax malaria Differences in the strains of viruses
Chloroquine with a higher dose Development of a cellular immune response in some
Artemeter (plus Lumefantrine) patients leading to the encephalic form of rabies
Mefloquine 20. Components of the Weils triad in leptospirosis except:
Primaquine Jaundice
12. Transmitted by a bat except: Arrhythmia
Rabies Hepatomegaly
Ebola Fever
H1N1 influenza (avian) Renal failure
None 21. Biphasic fever characterizes this disease:
13. A positive tuberculin test reaction of 10 mm induration is P vivax malaria
seen in the following except: Leptospirosis
Injection drug users Typhoid fever
Recent contacts of tuberculous patients Dengue Hemorrhagic Fever (saddleback: high fever
Children < 4 years old (<5 years old) ! normal ! low-grade fever)
Recent immigrants within 5 years from high 22. The only bacterial infection of humans for which the bone
prevalence countries marrow examination is recommended:
Residents and employees of prisons, nursing homes, Dengue hemorrhagic fever
hospitals and homeless shelters HIV
14. Malarial paroxysms lasting for hours with regular Salmonella typhi fever infection (IM platinum: first
periodicity coincide with week: blood ! 2nd week: urine/blood ! 3rd week:
Exit of merozoites into the bloodstream after stool/blood.
breaking down their host cell membrane Bone marrow if highly suspicious, even in negative
Synchronous rupture of blood schizonts associated results of blood/stool. Can be done anytime)
with high levels of TNF-alpha Staphylococcus aureus infection
Sequestration of infected erythrocytes in Malaria
microvascular beds 23. Patients with malaria, schistosomiasis or histoplasmosis
Breaking out of merozoites from their host are at increased risk of sever disease with this entity
erythrocytes in the bloodstream cycle S. typhi
Active entry of sporozoites into an indurated Bartononella henselae
parasiophorous vacuole in the hepatocyte SARS
cytoplasm H. pylori
15. A person infected with Ebola virus can resume MERS-CoV
unprotected sexual activity within this period: 24. Renal complications are rare in this disease:
14 days Malaria
28 days Leptospirosis
3 months Typhoid fever
6 months Dengue Hemorrhagic Fever
12 months 25. Differential diagnoses of DHF transmitted by the Aedes
16. HRIG is given egypti mosquito acquired from travel to infected locations:
Single dose at 20 IU/kg in adults, 10 IU/kg in Japanese B encephalitis
children Onyong-nyong virus
Single dose at 20 IU/kg in all age groups Malaria
Single dose at 40 IU in all age groups Yellow Fever
Single dose at 40 IU/kg in adults, 20 IU/kg in 26. False negative tuberculin test results can be caused by
children the following except:
17. Paralytic rabies exhibits the following except: Protein malnutrition
Hydrophobia Nontuberculous mycobacterial infection (false +)
Hypophonia Reticuloendothelial disease
Ascending paralysis Active TB disease
Neck stiffness HIV < 200 CD4+ T cells/ cubic meter
Normal sensorium Measles Vaccination
18. One recommendation for post-exposure rabies prophylaxis 27. CSF culture characteristics in CNS TB except:
(PEP): Increase CSF glucose
The vaccine may be given in the same region as the Elevated protein
Ig Lymphocytic predominance
Daily IM administration of PEP is allowed Polymorphonuclear pleocytosis
The vaccine can also be given at the gluteal area 28. Relative bradycardia is present in the following except:
apart from the deltoid area since neutralizing Dengue Fever
antibody titers will not be affected (fat cells = Typhoid fever
interfere with response) S. paratyphi A infection
Personnel who care for rabies patients should Amoebic liver abscess
maintain serum rabies antibody titer of 1 IU/ml 29. Concurrent infection with Salmonella typhi may affect the
even without exposure to potentially contaminated clinical course of this disease:
material (WHO = 0.5 IU)? Dengue
19. Some rabies cases with very long incubation period may Malaria (antibody cross-reactivity, )
be due to a: Schistosomiasis
Persistence of the virus in macrophages Hepatitis B
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30. Adult antibiotic prophylaxis for household or intimate Chloride [mmol/ 80 65
contacts of patients with meningococcal disease: L]
Pen G 1 gram IV q12 H for 2 days in adults
Ciprofloxacin 500mg q12 per orem for 2 days in Citrate [mmol/L] 10 10
adults
Ceftriaxone 1 gram IM single dose in adults Glucose [mmol/L] 111 75
Rifampicin 600 mg q 12 for 2 days in adults
Ciprofloxacin 1000 mg single dose in adults Osmolarity 311 245
[mOsml/L]
Management:
1. Tetanus- Tetanus Anti-toxin/Antibiotics (Metronidazole)
3. A 32 year-old male who came in at the ER because
2. Rabies: IVF, Diazepam
of high grade fever for 8 days who self-medicated
3. Liver Abscess: Metronidazole
Paracetamol but afforded no relief. 5 days PTA,
4. Leptospirosis: Doxycycline, Chemoprophylaxis
patient developed chills with colored light-brown
5. Malaria: Chloroquine & Sulfadoxine, Pyrimethamine
urine. He consulted a private MD and the following
6. Typhoid Fever: Chloramphenicol
medications were given: Paracetamol, Vitamins,
7. Diphtheria: Penicillin G. Sodium
and Co-Trimoxazole BID, affording no relief. Fever
8. Oral Candidiasis: Fluconazole
still high grade at 39-40 profuse sweating hence
9. Meningococcemia: Ciprofloxacin, Chemoprophylaxis
admission:
10. Snake bite: Anti-venom
a. Diagnosis:
b. At least 2 differential diagnosis:
IDENTIFY:
c. At least 2 diagnostic work-ups:
Herpes zoster: Painful vesicular eruption affecting the nerve
d. Management:
root ganglia
Schistosomiasis: Infection is acquired while a person is
4. A 5 month-old baby, weighing 8 kg, was brought at
wading in water contaminated with swimming larva cercaria.
the ER due to watery diarrhea and vomiting for 5
Liver abscess: Fever with severe right upper quadrant pain
times daily. Patient is pale looking, with sunken
and tenderness, hepatomegaly with or without jaundice.
eyes, skin pinch goes back slowly and eager to eat:
Endocarditis: A microbial infection of the endocardial surface
a. Degree of dehydration:
of the heart that has been classified as acute or sub-acute,
b. Basis for classification:
chronic.
c. Best fluid to use:
Meningococcemia: Patients with high frade fever with
d. Fluid resuscitation order:
purpuric rash or ecchymoses and rapid deterioration of
clinical condition.
5. A 26 year-old female came in at the ER because of
Cellulitis: Acute spreading infection of the skin extending
fever which is continuously high grade fever for 7
deeper to involve the subcutaneous tissue due to Group A
days associated with headache. Three days PTA,
Streptococcus or Staphylococcus aureus.
patient developed vomiting and diarrhea. She has
Acquired Immune Deficiency Syndrome: Diseases that
abdominal rashes which are erythematous, maculo-
pertains successful entry of the virus in the body and the
papular. Until four days PTA, diarrhea still persisted
main targets are the T-lymphocytes.
with high grade fever and she was advised for
Dengue Fever: The disease is transmitted through the bite of
admission.
a female mosquito with incubation period of about 2-7 days.
a. Diagnosis:
PTB Recurrence: A patient previously treated for PTB and has
b. At least 2 differential diagnosis:
been declared cured but diagnosed with bacteriologically
c. At least 2 diagnostic work-ups:
positive smear or culture.
d. Management:
Diphtheria: Disease of the oropharynx characterized by
grayish pseudomembrane.
6. Criteria for good attachment in breastfeeding
a. Babys mouth is wide open
Case Study:
b. You can see more areola above the babys
1. A 13 year-old kid weighing 35 kg was bitten by a
mouth than below
stray dog sustaining a laceration on the right
c. Babys lower lip turned outward
forearm and a punctured wound on the right arm
d. Babys chin is touching your breast
last July 23, 2014. Then the patient consulted last
July 24, 2014 in the OPD.
a. Category of exposure:
b. Vaccine/Vaccines given:
c. Complete ID schedule:

2. Composition of Reformulated ORS (WHO) with the

composition of the old ORS:

Old New

Sodium [mmol/L] 90 75

Potassium [mmol/ 20 20
L]

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