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SECTION II

 

INFECTIOUS DISEASES

 

1.        DIAGNOSTIC METHODS:

26.1              Match the following statements:

 

i.)                   Chlamydia

ii.)                  Pneumocystis carinii

iii.)                 Plasmodium leishmania

iv.)                 Respiratory syncytial virus

v.)                  Borrelia (relapsing fever)

 

1.)                  Wright’s stain

2.)                  Romanowsky stain

3.)                  Fluorescent antibody test

4.)                  Direct examination

5.)                  Giemsa stain

 

26.2              Answer true or false for the following statements:

 

i.)                   Even slight bacterial growth is significant with suprapupic urine collection

ii.)                  Urine specimen of > 10 WBCs in symptomatic men is suggestive of UTI

iii.)                 Optimal blood culture is 3 specimens of 5 ml each, 30 minutes apart

iv.)                 Regular fecal cultures can detect vibrio para hemolyticus

v.)                  Single throat swab culture is 90% positive for streptococcal pharyngitis

 

26.3              In cerebrospinal fluid, counter immuno-electrophoresis (CIE) is very sensitive test to detect the antigens of:

 

i.)                   Pneumococci

ii.)                  Staphylococci

iii.)                 Group D streptococci

iv.)                 H. influenza

v.)                  Meningococci

 

2.        INFECTIONS IN THE COMPROMISED HOST:

 

27.1              INFECTIONS IN THE COMPROMISED HOST:

 

i.)                  Ataxia-telangiectasia and T-lymphocyte dysfunction

ii.)                Multiple myeloma and B cell dysfunction

iii.)               Sickle cell disease and alternate pathway defect

iv.)               Chedak-Higashi syndrome and impaired cellular phagocytosis

v.)                Wiskolt-Aldrich syndrome and mixed T- and B-cell dysfunction

 

27.2              The following correlations are correct:

 

i.)                   Job’s syndrome and staphylococcus aureus

ii.)                  Splenectomy and Salmonella species

iii.)                 Selective IgA deficiency and Escherichia-Coli

iv.)                 Bruton’s x-linked agammaglobulinemia and Herpes simplex

v.)                  Sickle cell disease and Streptococcus penumoniae

 

3.        HOSPITAL-AQUIRED INFECTIONS:

 

28.1              The following statements are correct:

 

i.)                   Gram-negative bacilli can acquire and transfer antibiotic resistance by plasmids

ii.)                  Wound infections caused by staphylococci usually occur 24-48 hours post operatively

iii.)                 Pneumonia is the most common cause of mortality from hospital acquired infections

iv.)                 Putting obtunded patients in a swimmer’s position can predispose to post-operative pneumonia

v.)                  Legionnaire’s disease can be prevented by hyperchlorination or superheating of hospital tap water

 

4.        SEPTIC SHOCK:

 

29.1              Answer T or F.

 

i.)                   It is usually due to release of bacterial endotoxins

ii.)                  ARDS is the most important cause of death

iii.)                 Platelets are usually normal

iv.)                 Early respiratory alkalosis is followed later by metabolic acidosis

v.)                  Glucocorticoids are ineffective mode of therapy

 

5.        ANTIBIOTIC THERAPY:

 

30.1              The following drug-disease correla-tions are correct:

 

i.)                   Azocillin and pseudomonas infections

ii.)                  Sulfadiazine and toxoplasmosis

iii.)                 Chloramphenicol and chlamydia

iv.)                 Metronidazole and Shigella

v.)                  Influenza A and rimantadine

 

30.2              Ceftriaxone is active against:

 

i.)                   E. Coli

ii.)                  S. faecalis

iii.)                 Psuedomonas infections

iv.)                 N. meningitides

v.)                  S. pneumoniae

 

30.3              The following statements about drug therapy are correct:

 

i.)                   One in 25,000 patients develop aplastic anemia after taking chloramphenicol

ii.)                  Erythromycin decreases blood levels of theophylline

iii.)                 Rifampicin increases the effect of steroids

iv.)                 Metronidazole should not be given in pregnancy

v.)                  Acyclovir is more effective than vidarabine for herpes simplex encephalitis.

 

6.        PREVENTION OF INFECTION BY IMMUNIZA-TION:

 

31.1              Sabin type vaccine against poliomyelitis is different from Salk type by the fact that it is:

 

i.)                   A live attenuated vaccine

ii.)                  Formalin-inactivated

iii.)                 Given orally

iv.)                 Preferred during epidemic

v.)                  Selectively used in unimmunized adults

 

31.2              The following statements about immunization are correct:

 

i.)                   Cholera vaccine is only 50% effective in decreasing transmission of disease

ii.)                  Plague active vaccine is a formaldehyde dehydrozole inactivated Yersinia pestis

iii.)                 Typhoid fever active vaccine is usually given subcutaneously in two doses

iv.)                 Influenza vaccine reduces morbidity and mortality in those at risk of complications of influenza

v.)                  BCG vaccine is an inactivated bacilli, given intradermally

 

31.3              Passive immunization for measles with immunoglobumin is indicated in:

 

i.)                   Susceptible household contacts less than 1 year old

ii.)                  Exposed susceptible pregnant females

iii.)                 Exposed immunodeficient persons

iv.)                 Infants who have severe disease

v.)                  None of the above

 

7.        SEXUALLY TRANSMITTED DISEASES:

 

32.1              Microorganisms associated with Reiter’s syndrome include:

 

i.)                   C. trachomatis

ii.)                  N. gonorrhoea

iii.)                 Yersinia

iv.)                 Campylobacter

v.)                  Rickettsia

 

32.2              Treatment of gonococcal infections.  Mark T or F:

 

i.)                   Uncomplicated infections can be treated successfully by one does of ceftriazone 250 mg intramuscularly

ii.)                  Spectinomycin is used for penicillin resistant cases particularly pharyngeal infection

iii.)                 Tetracycline 0.5 g P.O. QID for 7 days should follow treatment of each case of gonorrhoea

iv.)                 Disseminated infection is best treated by a third generation cephalosporin

v.)                  VDRL should be checked after therapy in all patients

 

32.3              In lymphogranuloma venereum:

 

i.)                   Primary lesion is a painless vesicle or papule

ii.)                  Painful inguinal adenopathy is a known feature

iii.)                 Diagnosis is obtained by culture of aspirated bubo

iv.)                 Compliment fixation of 1:32 is suggestive of diagnosis

v.)                  Treatment of choice is metronidazole 500 mg P.O. Q8h for 7 days

 

8.        INFECTIOUS DIARRHEA:

 

33.1              Enterotoxogenic E. coli.  Mark T or F.

 

i.)                   It causes the majority of traveler’s diarrhea

ii.)                  Incubation period is usally 12-24 hours

iii.)                 It is a non invasive pathogen causing watery diarrhea most of the time

iv.)                 Antibiotics offer symptomatic relief but duration of the illness remains the same

v.)                  Prophylaxis can be achieved by doxycycline 100 mg once daily

 

33.2              The following statements about pathogens causing diarrhea are correct:

 

i.)                   Clostridium perfringens diarrhea rarely lasts more than 24 hours

ii.)                  Staphylococcus aureus diarrhea has a high attack rate

iii.)                 Campylobacter jejuni is transferred by contaminated water or raw milk

iv.)                 Campylobacter fetus is usually non-pathogenic in humans

v.)                  Rota virus is responsible for 40-50% of travelers diarrhea

 

9.        PNEUMOCOCCAL INFECTIONS:

 

34.1              The following statements are correct:

 

i.)                   50% of cases of pneumococcal pneumonia are associated with pleural effusion which is usually sterile and resolves spontaneously

ii.)                  Blood cultures are positive in 10-15% of cases of pneumococcal pneumonia

iii.)                 CSF latex agglutination or CIE are positive in 80% of cases of pneumococcal meningitis

iv.)                 Pneumococcal endocarditis is usually a complication of pneumonia or meningitis

v.)                  Incidence of pneumococcal peritonitis is increased in post-partum period

 

34.2              Chest tuber insertion is indicated if pleural effusion shows:

 

i.)                   Presence of bacteria

ii.)                  PUS

iii.)                 Ph < 7.0.

iv.)                 Glucose < 50 mg/dl

v.)                  LDH of fluid to serum ratio > 0.6

 

 

10.     STAPHYLOCOCCAL INFECTIONS

 

35.1              Diagnostic criteria of toxic shock syndrome include:

 

i.)                   Diffuse “sunburn” rash that desquamates on palms and soles over 1-2 weeks

ii.)                  Thrombocytopenia

iii.)                 Myalgia with normal C.K.

iv.)                 Disorientation with normal CSF

v.)                  Profuse vaginal discharge

 

35.2              In staphylococcal osteomyelitis:

 

i.)                   Children younger than 6 years are especially susceptible

ii.)                  Preceding superficial staphylococcal infection occurs in only 10% of the cases

iii.)                 Radionuclide scan may be abnormal in the first week of the illness

iv.)                 Sinus tract cultures are not reliable in chronic disease

v.)                  Vancomycin is the drug of choice in penicillin allergic patients

 

11.     STREPTOCOCCAL INFECTIONS:

 

36.1              Streptococcal pharyngitis.  Mark T or F.

 

i.)                   Most common age is 5 – 15 years

ii.)                  It is normally group B

iii.)                 High ASO titre confirms diagnosis of streptococcal infection

iv.)                 Treatment with penicillin prevents acute rheumatic fever if given within 3 days of onset of infection

v.)                  Erythromycin is an alternative drug in penicillin-allergic patients

 

36.2              Match the following on acute skin streptococcal infections.

 

i.)                   Spreading erythema on the face with vesicles and bullae

ii.)                  Affects skin and subcutaneous tissue with fever, pain and erythema, margins not elevated

iii.)                 Localized purulent infection, papules and vesicles with surrounding erythema especially in lower limbs

iv.)                 Diffuse rash, blanching erythema sparing palms and soles, sandpaper texture, followed by desquamations

v.)                  Red linear streaks with chills, fever and malaise

 

1.)                  Scarlet fever

2.)                  Erysipelas

3.)                  Lymphangitis

4.)                  Cellulits

5.)                  Impetigo

 

12.     ANAEROBIC INFECTIONS:

 

37.1              In tetanus:

 

i.)                   Only 10 – 20% give history of injury

ii.)                  10-20% have no detectable lesion

iii.)                 Rigidity and reflex spasms occur 2 – 3 days after onset of the disease

iv.)                 Complete recovery usually occurs in 4 weeks

v.)                  Clostridium tetani is recovered from wound in only 30% of the cases

 

37.2              In botulism:

 

i.)                   Incubation period is 2-21 days

ii.)                  Wound botulism is cause by contamination with solid containing viable pathogens

iii.)                 Cathartics and enemas are indicated to remover unabsorbed toxin

iv.)                 Food-borne botulism can occur after contamination with spores only

v.)                  Trivalent antitoxin is given only after sensitivity testing to horse serum

 

13.         DISEASES CAUSED BY OTHER GRAM-POSITIVE ORGANISMS:

 

38.1              In diphtheria:

 

i.)                   Spread is usually by droplet transmission

ii.)                  Wounds, burns or abrasion may be invaded

iii.)                 Erythromycin is effective in chronic carrier states

iv.)                 Club-shaped gram-positive rod organisms are seen on methylene blue

v.)                  Culture is done using Loefflers medium

 

38.2              In listeria moncyutogenes:

 

i.)                   Food-borne outbreaks occur

ii.)                  Incidence in diabetic patients is increased

iii.)                 Sepsis is seen in newborns

iv.)                 Amphotericin B is effective therapy

v.)                  Bloody diarrhea may occur

 

14. MENINGOCOCCAL MENINGITIS:

 

39.1              Answer T or F.

 

i.)                   Attack rate is highest between ages 2 and 6 years

ii.)                  Petechial rash is seen in about 75% of the patients

iii.)                 Waterhouse-Friderichsen syndrome occurs in 10-20% of patients

iv.)                 Abrupt onset of confusion is a very common presentation

v.)                  Cranial nerve palsies occurring as a complication of meningitis usually clear within 2 – 4 months

 

15. HAEMOPHILUS INFECTIONS

 

40.1              Haemophilus influenza:

 

i.)                   Primarily affects children 6 to 48 months old

ii.)                  Increased incidence in patients with sickle cell disease

iii.)                 Most common bacterial meningitis in children 4 – 6 years old

iv.)                 Antigens detected from serum, CSF or urine

v.)                  Prophylaxis can be achieved by rifampicin 20 mg/kg dialy for 4 days

 

16.         DISEASES CAUSED BY GRAM-NEGATIVE ORGANISMS:

 

41.1              Match the following set of statements:

 

i.)                   Malignant otitis in diabetics

ii.)                  Causes > 75% of urinary tract infections

iii.)                 Gram’s stain may be suggestive of diagnosis because of large capsule

iv.)                 Associated with obstructive uropathy

v.)                  Punched out skin ulcers with regional lymphadenopathy

 

1.)                  Proteus mirabilis

2.)                  Pseudomonas auraginosa

3.)                  Klebsiella Francisella tularensis

4.)                  Francisella tularensis

5.)                  E. Coli

 

41.2              In brucellosis:

 

i.)                   Exposure occurs through infected tissue

ii.)                  Spleen is enlarged in 40-50% of patients

iii.)                 IgG correlates with active infection

iv.)                 Titers of > 1:80 is suggestive of the diagnosis

v.)                  Tetracycline is an effective prophylaxis

 

17.     TUBERCULOSIS & OTHER MYCOBACTERIAL INFECTIONS:

 

42.1              Tuberculous pleural effusion.  Mark T or F.

 

i.)                   It usually occurs in young patients

ii.)                  Simultaneously pulmonary tuberculosis is very common

iii.)                 PPD skin test is negative in 30% of the cases

iv.)                 It has good response to treatment

v.)                  Empyema requires surgical drainage

 

42.2              In military tuberculosis:

 

i.)                   Fine nodules on chest x-ray occur 4 – 6 weeks after onset of illness

ii.)                  Liver and bone marrow biopsies are positive in two-thirds of the cases

iii.)                 PPD skin test is often negative

iv.)                 Choroid tubercles are known features

v.)                  Steroid therapy is an essential part of the treatment

 

42.3              Match the following:

 

i.)                   Small painless nodule which progresses to granulomatous lesion on extremeties

ii.)                  Infection form exposure to fresh water, responds to tetracycline

iii.)                 Organism develops pigment with exposure to light identified by prominent transverse bonding

iv.)                 Lymphadenitis is children

v.)                  Grows within 1 – 5 weeks on most media, and responds to cefoxitin or erythromycin

 

1.)                  M. murinum

2.)                  M. scrofulaceum

3.)                  M. scrofulaceum

4.)                  M. Kansasi

5.)                  M. forotuitum

 

18.     INFLUENZA AND OTHER VIRAL RESPIRATORY DISEASES:

 

43.1              Complications of influenza infection include:

 

i.)                   S. aureus pneumonia

ii.)                  Reye’s syndrome

iii.)                 Persistent hyponatremia

iv.)                 Myositis and rhabdomyolysis

v.)                  Chorioretinitis

 

43.2              The following associations are correct:

 

i.)                   Rhinovirus:  spread by contact with infected secretions

ii.)                  Coronaviurs:  major respiratory pathogen of young children

iii.)                 Respiratory syncytial virus:  causes 10-20% of cases of common cold

iv.)                 Para influenza virus:  major cause of croup

v.)                  Adenovirus:  hemorrhagic cystitis and epidemic keratoconjunctivitis

 

19.         RUBEOLA, RUBELLA, CHICKEN POX AND OTHER VIRAL EXANTHEMS:

 

44.1              Complications of measles include:

 

i.)                   Croup

ii.)                  Interstitial giant cell pneumonia

iii.)                 Vaccinia gangrenosum

iv.)                 Acute glomerulonephritis

v.)                  Subacute bacterial endocarditis

 

44.2              In herpes zoster:

 

i.)                   Latent virus reactivation originates from dorsal root ganglia

ii.)                  Cutaneous dissemination occurs in 75% of cases if associated with lymphoma

iii.)                 Granulomatous angiitis with contralateral hemiplegia is a known complication

iv.)                 Tzanck smear is a useful method for diagnosis

v.)                  Live attenuated vaccine should be given as prophylaxis

 

20.     MUMPS:

 

45.1              In mumps.  Mark T or F for the following:

 

i.)                   Paramyxovirus reservoir is present only in humans

ii.)                  Virus is transmitted by infected salivary secretions or urine for 6 days prior to parotitis and up to 2 weeks later

iii.)                 Marked leukocytosis is seen if orchitis occurs

iv.)                 Prednisone may give symptomatic relief in orchitis

v.)                  Prevention is achieved by a live attenuated vaccine given after 1 year of age

 

21.     ENTEROVIRUSES AND REOVIRUSES:

 

46.1              The following statements are correct:

 

i.)                   Picornaviruses are small RNA viruses that can survive in sewage and chlorinated water

ii.)                  Risk of paralysis from oral poliovaccine is 1 in 1.7 million doses

iii.)                 Herpangina is caused by coxsackie B-viurs

iv.)                 Epidemic myalgia is caused by coxsackie virus A.

v.)                  Reoviruses are single stranded RNA viruses that cause upper respiratory infections

 

22.     HERPES SIMPLEX VIRUSES (HSV):

 

47.1              The following statements are correct about drug treatment of HSV:

 

i.)                   Treatment of choice for the first episode of genital herpes is oral acyclovir 200 mg orally 5 times per day for 10-14 days

ii.)                  In symptomatic recurrent genital herpes, short course of oral acyclovir has modest benefit in shortening lesions and viral excretion time

iii.)                 Prolonged use of oral acyclovir 2 – 3 times daily prevents reactivation of symptomatic recurrences of genital herpes

iv.)                 Acyclovir given intravenously in HSV encephalitis has no effect on overall mortality

v.)                  In oral-labial HSV infection topical acyclovir is of no clinical benefit

 

23.         CYTOMEGALOVIRUS (CMV) AND EPSTEIN-BARR VIRUS (EBV) INFECTIONS:

 

48.1              CMV infection.  Mark T or F.

 

i.)                   Maximum risk is 2-3 weeks after organ transplant

ii.)                  CMV pneumonia occurs in 20% of bone marrow recipients

iii.)                 CMV infection is very frequent in patients with AIDS

iv.)                 Urine or saliva may be culture positive for months or years after infection with CMV

v.)                  Most congenital CMV infections are clinically inapparent at birth

 

48.2              In EBV infections:

 

i.)                   EBV is rarely transmitted by blood transfusiosn

ii.)                  Infected B lymphocytes are polyclonally stimulated to produce immunoglobulins

iii.)                 Splenomegaly occurs in almost all the cases

iv.)                 Corticosteroids are contraindicated

v.)                  Burkitt’s lymphoma is a known association

 

48.3              Complications of EBV infection include:

 

i.)                   Autoimmune hemolytic anemia

ii.)                  Splenic rupture during the early phase of disease

iii.)                 Spontaneous pneumothorax

iv.)                 Encephalitis

v.)                  Pericarditis

 

48.4              Correct statements about diagnosis of EBV infection include:

 

i.)                   Heterophil antibodies are antibodies to sheep red blood cells removed by absorption with beef red blood cells

ii.)                  20-30% of cases may be negative for HA in the first week of the illness

iii.)                 HA may be positive upto 9 months after onset of the illness

iv.)                 Atypical lymphocytes that are usually seen are in fact activated B-lymphocytes

v.)                  IgM to viral capsid antigens are diagnostic of primary infection

 

 

 

1.    IN RABIES:

 

49.1              Mark T or F.

 

i.)                   Human to human transmission can occur

ii.)                  Prominence of early brain stem dysfunction distinguishes rabies encephalitis from other encephalitis

iii.)                 Hydrophobia occurs in almost all cases

iv.)                 Neutralizing antibody titer of > 1:64 should be maintained for effective pre-exposure prophylaxis

v.)                  Active immunization is achieved by giving human rabies immune globulin (RIG)

 

2.        FUNGAL AND RELATED INFECTIONS:

 

50.1              In cryptococcosis:

 

i.)                   Infection occurs through inhalation or skin abrasions

ii.)                  Meningoencephalitis, pneumonitis and uveitis are known clinical manifestations

iii.)                 India ink stain of CSF is positive in about 50% of the cases

iv.)                 Lung biopsy is required for diagnosis

v.)                  Flucytosine and ketoconazole are equally effective therapy

 

 

50.2              In candidiasis:

 

i.)                   Diagnosis is by demonstration of psuedohyphae on wet smear

ii.)                  Chronic mucocutaneous candidiasis is associated with hyperparathyroidism, hyperthyroidism or T cell function defects

iii.)                 Appearance of retinal abscess is a feature of hematogenous spread

iv.)                 Imidazole cream is effective for cutaneous candidiasis

v.)                  Urine infection is treated by bladder irrigation with amphotericin B or flucytosine diluted solutions for 15 days

 

50.3              Aspergillosis:  Mark T or F.

 

i.)                   It is acquired through inhalation of spores of the fungus

ii.)                  Aspergilloma represents a ball of hyphae within a lung cyst or cavity

iii.)                 Chronic sinusitis occurs usually in the non immuno-suppressed

iv.)                 Repeated isolation of aspergillous from sputum more than two times is indicative of infection

v.)                  Amphotericin B can arrest or cure hemoptysis due to aspergilloma

 

50.4              Features of allergic bronchial aspergillosis include:

 

i.)                   Pre-existing asthma

ii.)                  Eosinophilia

iii.)                 IgG antiboidies to aspergillus

iv.)                 Hilar adenopathy

v.)                  Fleeting pulmonary infiltrate

 

50.5              Findings in mucormycosis include:

 

i.)                   Rhizopus fungus infection

ii.)                  Malignant otitis media

iii.)                 Non septate hyphae

iv.)                 Immunocompromised host

v.)                  Poor response to amphoreticin B

 

50.6              The following correlations are true:

 

i.)                   Weekly acid-fast organisms and actinomycosis

ii.)                  Painless red papule at the site of inoculation and sporotrichosis

iii.)                 Response to sulfisoxazole and nocardiosis

iv.)                 Osteolytic lesions and histoplasmosis

v.)                  Hilar or paratracheal lymphadenopathy and coccidioidomycosis

 

3.        RICKETTSIAL INFECTIONS:

 

51.1              The following features favor endemic type (murine) rather than the epidemic type (louse-borne).

 

i.)                   Infection by Rickettsia prowazekii

ii.)                  Maculcopapular rash affecting axilla, upper abdomen with little involvement of the extremities

iii.)                 Azotemia, thrombosis and cutaneous gangrene

iv.)                 Rapid recovery with little fatalities in most cases

v.)                  Positive Weil-Felix OX-19

 

51.2              Q-fever.  Mark T or F.

 

i.)                   It is acquired by inhalation of dust or drinking contaminated milk

ii.)                  Coxiella burnetti is the causative organism

iii.)                 Granulomatus hepatitis occurs in one-third of the cases

iv.)                 Culture negative subacute bacterial endocarditis is a known complication

v.)                  Chloramphenicol is an effective treatment

 

4.        MYCOPLASMA INFECTIONS:

 

i.)                   Protective antibodies from an infection give a life long immunity

ii.)                  IgM antibodies to I antigen on type O RBC are positive in about half of the cases

iii.)                 Tetracycline is an effective therapy

iv.)                 WBC count is normal in over 80% of the cases

v.)                  Stevens-Johnson syndrome is a recognized complication

 

5.        CHLAMMYDIAL INFECTIONS:

 

53.1              Chlamydia trachomatis genital infection.  Mark T or F:

 

i.)                   Chlamydia is a major cause of epididymitis in men under the age of 35 years

ii.)                  Complications include peri-rectal abscess, fistula and strictures

iii.)                 Up to 70% of men with non-diarrheal Reiter’s disease have a positive test

iv.)                 Mucopurulent cervicitis and pelvic inflammatory disease are known clinical manifestations in females

v.)                  All patients with gonorrhea and their sexual partners should be treated for chlamydia infection

 

53.2              In psittacosis:

 

i.)                   Respiratory transmission occurs from any avian species

ii.)                  Splenomegaly is uncommon

iii.)                 Liver function tests are usually normal

iv.)                 Diagnosis can be obtained by culture or serology

v.)                  Six weeks course of tetracycline is the regimen of choice

 

53.3              In lymphogranuloma venereum (LGV):

 

i.)                   Two strains (L1 and L2) are recognized pathogenic forms

ii.)                  Primary genital lesions occurs 3 to 10 days after exposure

iii.)                 Inguinal syndrome is unilateral in 10 – 20% of the cases

iv.)                 Headache and menigismus are known constitutional symptoms

v.)                  Complement fixation titre of > 1:64 is suggestive of the diagnosis

 

6.        PARASITIC DISEASES:

 

54.1              In amebiasis:

 

i.)                   There is increased SGOT and bilirubin in the hepatic form

ii.)                  Pleuropulmonary extension occurs in 1 – 3% cases

iii.)                 Motile trophozoites can be recovered from liquid stools

iv.)                 Pericarditis is a recognized extra-intestinal manifestation

v.)                  Serology is positive in over 90% of patients with hepatic abscess

 

54.2              Match the following statement on malaria blood smear:

 

i.)                   Small rings with two chromatin dots and banana-shaped gametocyts

ii.)                  “Band” forms

iii.)                 Immature (enlarged) red blood cells and diffuse red dots (Schuffner’s dots).

iv.)                 Oval shaped red blood cells

 

1.)                  P. vivax

2.)                  P. falciparum

3.)                  P. malariae

4.)                  P. ovale

 

54.3              The following statement are correct about malaria:

 

i.)                   Parasitemia is limited in patients with thalassemia

ii.)                  Blackwater fever is triggered by immunecomplex nephropathy

iii.)                 Exchange transfusion is indicated if parasitemia reaches > 10%

iv.)                 Dexamethazone and/or manitol are indicated in severe falciparum infection

v.)                  Amodiaquine prevents relapse of P. vivax and P. ovale

 

54.4              In toxoplasmosis:

 

i.)                   Acute acquired infection is usually seen in an immunocompetent host

ii.)                  The disease is responsible for about one third of all chorioretinitis cases

iii.)                 CNS is rarely affected even in an immunocompromised host

iv.)                 Trophozoites can be demonstrated in histology of tissue sections

v.)                  Combination of sulfadiazine and primaquine is the best therapy

 

54.5              In pneumocystic carinii pneumonia:

 

i.)                   Infection is a reactivation in most cases

ii.)                  Risk of infection is increased in children with primary immunodeficiency

iii.)                 Diagnosis is usually obtained by methenamine silver stain of sputum

iv.)                 Cotrimoxazole causes drug rash in about 50% of treated AIDS patients

v.)                  Pentamidine could be given by inhalation, IM, or IV routes

 

54.6              Pentamidine can cause:

 

i.)                   Hypoglycemia

ii.)                  Hyperglycemia

iii.)                 Hypocalcemia

iv.)                 Hyperuricemia

v.)                  Hepatic dysfunction

 

54.7              In schistosomiasis:

 

i.)                   Pathology is dependent on duration and intensity of exposure

ii.)                  Acute schistosomiasis syndrome may last 2-3 months

iii.)                 Liver fibrosis can be caused by S. Mansoni or S. Japonicum

iv.)                 Glomerulonephritis and systemic hypertension are known clinical manifestations

v.)                  Hydronephrosis and renal failure are common sequelae of S. hematobium infection

 

54.8              The following associations are correct about intestinal nematodes:

 

i.)                   Trichuriasis (whipworm) and pruritus ani

ii.)                  Ascariasis and malabsorption

iii.)                 Ankylostoma and subconjunctional hemorrhage

iv.)                 Trichinosis and autoinfection

v.)                  Isosporiasis and infection by penetration of the skin

 

7.        OTHER INFECTIONS OF CLINICAL IMPORTANCE:

 

55.1              Legionella infections.  Mark T or F.

 

i.)                   They are anaerobic gram-negative rods with complex growth requirement

ii.)                  Risk of infection is increased with smoking

iii.)                 Gastrointestinal symptoms are seen in almost all cases

iv.)                 10-15% of cases are complicated by respiratory failure

v.)                  Erythromycin or tetracycline are effective therapy

 

55.2              The following statements are in favor of tuberculous leprosy rather than lepromatous type

 

i.)                   Hypopigmented macules

ii.)                  Palpable greater auricular nerve

iii.)                 Corneal ulceration

iv.)                 Nasal obstruction

v.)                  Loss of the lateral eyebrow

 

55.3              The following statement are correct about Lyme disease:

 

i.)                   Borrelia birgdoroferi is the causative organism

ii.)                  Erythema chronicum migrans indicates the beginning of stage 2 disease

iii.)                 Stage 3 is manifested by CNS abnormalities

iv.)                 Increased IgG titre may cross react with Trepanoma pallidum

v.)                  Penicillin is an effective therapy