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 16th 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
16th ed, p. 107):
A. Acetaminophen is a poor cyclooxygenase inhibitor in peripheral tissue and has
no significant anti-inflammatory activity. centrally acting
B. Acetaminophen is preferred over aspirin because it has better antipyretic activity.
same 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.- there is no
significant clinical evidence that antipyretics delay the resolution of viral or
bacterial infections, nor is there evidence that fever facilitates recovery from
infection or acts as an adjuvant to the immune system. In fact, peripheral PGE2
production is a potent immunosuppressant. In short, treatment of fever and its
symptoms does no harm and does not slow the resolution of common viral and
bacterial infections.
E. Although glucocorticoids have excellent anti-inflammatory activity, they have
minimal effect on fever. effective antipyretics. Acts on two levels: 1: rewduces
PGE 2 sythesis by inhibiting the activity of phospholipase A2 2. Block the
transcription of the mRNA for the pyrogenic cytokines.

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): - necrotizing fascitis
A. Most common organisms causing this condition are group A streptococci,
coagulase negative staphylococci, and Pseudomonas aeruginosa. - group A
strep, mixed facultative and anaerobic flora, clostridium
B. Patients may present with bacteremia and hypotension without other organ-
system failure.
C. 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.
D. In some patients who remain untreated, a sign of improvement is the decrease in
the pain of the affected area. decrease in pain is not an improvement
E. The mortality rate among patients who do not undergo surgical intervention
approaches 50%. 30 percent (but m not sure)

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

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 B. Ceftriaxone 2 g/d IV as single dose for 4 weeks penicillin susceptible and
HACEK
C. Penicillin G 2 -3 million units IV q4 for 4 weeks strep
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 staph

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 16 th 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. mrsa and gram negative
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.- vanco and genta
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 16th ed, p. 742):
A. Impetigo contagiosa Streptococcus pyogenes
B. Bullous impetigo Staphylococcus aureus
C. Hot-tub folliculitis Pseudomonas aeruginosa
D. Erysipelas Staphylococcus aureus - strep
E. 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 16th, 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. - PMNS
C. While enteric gram-negative bacilli such as Escherichia coli are most frequently
encountered, anaerobes are also often found. gram positive
D. Third generation cephalosporins such as cefotaxime provide reasonable initial
coverage in moderately ill patients.
E. 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. 70% intraperitoneal or retroperitoneal
C. Diverticular abscesses are least likely to rupture.
D. When abscesses occur in the female genital tract, a common isolate is
Bacteroides fragilis.
E. Most visceral abscesses result from fecal spillage from a colonic source, such as
an inflamed appendix. not visceral but peritoneal

11. The following microorganisms cause non-inflammatory diarrhea via the production of
enterotoxins (HPIM 16th ed, p. 755):
A. Vibrio cholera

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 B. Salmonella typhi cell itself
C. Shigella spp. bacteria itself
D. Clostridium perfringens
e. Staphylococcus aureus

12. The following antibiotics have been found to cause Clostridium-difficile associated
disease (CDAD) (HPIM, 16th 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, 16th 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
16th 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 16th 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 16th 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.

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E. The most common pathogens involved in nosocomial UTI are E. coli, nosocomial
gram-negative bacilli, and MRSA.

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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 16th ed, p. 821):
A. Treatment for Staphylococcus aureus bacteremia is generally prolonged (4 to 8
weeks), due to its many well-recognized complications.
B. Patients with persistently positive blood cultures after 24 hours of antibiotics are
at increased risk of complicated bacteremia.
C. Second and third generation cephalosporins have a therapeutic advantage over
first-generation cephalosporins in the treatment of staphylococcal infections.
D. The crabapenems should be reserved for methicillin-resistant Staph. aureus
infections.
E. 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.

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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 16 th
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. Your friends blood cultures may give a positive yield of as high as 90% if you
obtain them after the 3rd week of his illness.
D. Bone marrow cultures remain highly sensitive even if your friend has been on
antibiotics for 5 days.
E. 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.

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 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 16th 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 16th 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 16th 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 16th ed., p. 967):
A. Nasal droplet infection
B. Contact with infected soil
C. Skin-to-skin contact
D. Fecal-oral route
E. Insect vectors

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
iii. 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

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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 16th
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 16th 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.

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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 false-positive 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. The prodromal period of this illness usually lasts 1 to 4 days.
B. The presence of paresthesias and/or fasciculations at or around the site of the
cat bite is a prodromal symptom of this disease.
C. Majority of these patients will demonstrate Negri bodies on pathologic
examination of the brain, such that their absence would rule out the diagnosis.
D. The manifestations of brainstem dysfunction begin shortly after the onset of the
encephalitic phase.
E. 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.

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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 16th 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 16th
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 16th ed., p. 1169 1170):
A. Lassa Fever
B. West Nile Virus Infection
C. Chikungunya Virus Infection
D. Hantavirus Pulmonary Syndrome
E. Yellow Fever

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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. Splenomegaly
B. Burkitts Lymphoma
C. Sickle Cell Disease
D. Recurrent hypoglycemia
E. 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 16th 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.

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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. Primary Sjogrens Syndrome
D. Myasthenia gravis
E. 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

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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 16th 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, 16th 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 16th ed., p. 1141 1142)
A. Norwalk virus
B. Rotavirus
C. Echovirus
D. Enteric adenovirus
E. Astrovirus

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19. For schistosomiasis endemic in the Philippines, how should drug therapy be
administered to adults? (HPIM 16th 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 16th 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. Diethylcarbamazine
C. Praziquantel
D. Ivermectin
E. 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. Within the 1st week of illness
C. On the second week of illness
D. On the third week of illness
E. 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

14
28. What is the most common cause of transient aplastic crisis in patients with chronic
hemolytic disease? (HPIM 16th 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 16 th 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. Varicella
B. Influenza
C. Pneumococci
D. Diphtheria and tetanus
E. BCG

15
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 16th 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
14th 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. They are all transmitted by the tick Ixodes scapularis.
D. They all respond to penicillin.
E. 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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