ETAS_MCQ_08 infectious diseases of the skin


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ETAS_MCQ_08 infectious diseases of the skin

  1. 1. Infectious diseases of the skin1) The causative organism for Brucellosis is which of the following:A. Acid fast bacilliB. Gram positive cocciC. Gram negative rodCorrect ChoiceD. Gram positive rodE. Gram negative cocciBrucella species which cause Brucellosis are gram negative rods. Brucellosis, aka undulant fever, ischaracterized by an acute febrile illness with headache and joint pain. CNS and cardiacmanifestations can also occur. It is acquired by contact with infected animals or contaminated dairyproducts. Treatment is with doxycycline and rifampin2) What is the most likely diagnosis of this lesion occurring on the hand of a butcher?A. Hecks diseaseB. Butchers wartC. Contagious ecthymaCorrect ChoiceD. Molloscum contagiosumE. Ecthyma gangrenosumContagious ecthyma, or orf, occurs most frequently among shepherds and butchers as it is a viraldisease that is more common among sheeps and goats. It is caused by a farmyard pox, which alsocause Milkers nodules. The lesions tend to heal spontaneously after several weeks3) For which of the following smallpox vaccination complications is the administration of vaccineimmune globulin indicated?A. Vaccinia keratitisB. Mild generalized vacciniaC. Post-vaccinal encephalitisD. Eczema vaccinatumCorrect ChoiceE. Erythema multiformeVaccinia immune globulin can be administered to treat some of the complications associated withvaccinia vaccination. Vaccinia immune globulin is indicated for inadvertent inoculation withextensive involvement or ocular implantations, eczema vaccinatum, generalized vaccinia (severe orrecurrent), and progressive vaccinia. It is not recommended for inadvertent inoculation with mildreaction, generalized vaccinia (mild or limited), post-vaccination encephalitis, and isolated vacciniakeratitis4) What characteristic color is seen on diascopy of this lesion?A. Coral redB. OrangeC. Blue 1
  2. 2. D. RedE. Apple jellyCorrect ChoiceLeishmaniasis recidivans is a type of Old World leishmaniasis. Clinically, it appears as a red papulecovered with white scale. On diascopy, it has a characteristic apple jelly color5) Measles is caused by a:A. TogavirusB. RhabdovirusC. PicornavirusD. ParamyxovirusCorrect ChoiceE. AdenovirusThe measles virus is an RNA virus belonging to the Paramyxovirus family6) Contagious pustular dermatitis (Orf) is caused by a:A. Poxvirus Correct ChoiceB. Gram-positive spore-forming rodC. PapovavirusD. HerpesvirusE. ParamyxovirusOrf is caused by orf virus (OV), a poxvirus of the genus Parapoxvirus7) Butchers warts are caused by which human papilloma virus (HPV) type?A. 7Correct ChoiceB. 2C. 5D. 3E. 13Butchers warts are caused by HPV type 78) An 18-year old man presents to the Dermatology Clinic with a nontender penile erosion that hasbeen present for 2 weeks. An indurated border and nontender bilateral inguinal lymphadenopathyare also noted. What is the most likely diagnosis?A. Lymphogranuloma venereumB. Herpes simplexC. ChancroidD. Primary syphilisCorrect ChoiceE. HIVA painless chancre with an indurated border is characteristic of primary syphilis. Associated painlesslymphadenopathy ("buboes") is also a common feature 2
  3. 3. 9) What is the causative agent of this parasitic eruption which also causes patchy pulmonaryinfiltrate and eosinophilia?A. FilariasisB. DracunculiasisC. Larva migransCorrect ChoiceD. Larva currensE. GnathostomiasisLarva migrans is caused by Ancylostoma braziliense, a hookworm of cats and dogs. It alsoassociated with Loefflers syndrome, patchy infiltrate of the lungs with eosinophilia. Treatment forthis parasitic infection is ivermectin or albendazole10) One of your colleagues returned from a vacation to India with fever, vomiting, pleural effusions,ascites and conjunctival petechiae. She also has a diffuse macular rash with notable areas ofsparing that your attending refers to as “white islands in a sea of red”. What is your diagnosis?A. MalariaB. LeishmaniaC. LeptospirosisD. TyphoidE. Dengue hemorrhagic feverCorrect ChoiceDengue fever is caused by an Arbovirus and transmitted by the mosquito, Aedes aegypti and maycause Dengue Shock Syndrome and Dengue Hemorrhagic Fever. The infection starts with suddenonset of high fever, backache, retroorbital pain, bone and joint pain, depression and malaise. Thedisease is also called "break-bone fever." One to seven days after onset of fever, rash presentscharacteristically starting on the dorsum and hands and feet spreading to limbs and torso. Theeruption may become confluent with small, round islands of sparing, the so called "white islands ina sea of red." Treatment is generally supportive as no antivirals are effective11) The treatment of choice for acyclovir-resistant herpes simplex virus infection is:A. SaquinivirB. ValcyclovirC. IndinivirD. FoscarnetCorrect ChoiceE. FamciclovirFoscarnet directly inhibits viral DNA polymerase (without requiring phosphorylation by TK) and istherefore effective in acyclovir-resistant HSV infections. Cidofovir can also be used12) Tricomycosis axillaris is caused by:A. Burkholderia malleiB. Corynebacterium tenuis Correct ChoiceC. Proteus species 3
  4. 4. D. Micrococcus sedentariusE. Corynebacterium minitissimumCorynebacterium tenuis13) Which of the following are inconsistent with the diagnosis of staphylococcal scalded skinsyndrome?A. Prognosis is good in children with low mortality when anitbiotics are administered earlyB. Swabs and cultures of fluid filled blisters overwhelmingly grow staphCorrect ChoiceC. Initial event is usually a localized staph infectionD. Cell necrosis does not occur in staphylococcal scalded skin syndrome as it does in T.E.NE. Epidermal changes are produced by exfoliative toxins of staphlococcusStaphylococcal scalded skin syndrome: Lesions extend far beyond areas of actual staphylococcalinfection, by action of the epidermolytic exotoxin elaborated by the staphylococcus in remote sites.Usually the staphylococci are present at a distant focus such as the parynx, nose ear, or conjuctiva.If cultures are taken they should be obtained fromthe mucous membranes because the skinerythema and desquamation is due to the distant effects of the exfoliative toxin, unlike the sitautionin bullous impetigo, where S. aureus is present in the lesions. Epidermal changes are produced byexfoliative toxins of Staphylococcus. Inital event is usually a localized Staph infection. Prognosis isgood in children with low mortality when anitbiotics are administered earyl. Cell necrosis does notoccur in SSS as it does in toxic epidermal necrolysis14) Which of the following is the vector for Dengue fever?A. Lutzomyia verrucarumB. Phlebotomus papatasiiC. Xenopsylla cheopisD. Aedes aegyptiCorrect ChoiceE. Culex mosquitoDengue fever also known as "break-bone" fever is characterized by sudden high fever, backache,retro-orbital pain, bone/joint pain, weakness, and malaise. It is caused by an arbovirus (RNA virus)which is transmitted by Aedes aegypti, a species of mosquito15) Which virus is most commonly associated with oral hairy leukoplakia?A. Human papilloma virusB. Epstein-Barr virusCorrect ChoiceC. ParvovirusD. Pox virusE. Herpes virusOral hairy leukoplakia is an oral mucosal infection most often caused by the Epstein-Barr virus,which occurs in immunocompromised patients. Clinically, thick, white plaques are noted on thelateral sides of the tongue, often fissured16) Which Rickettsial infection has a negative Weil-Felix test? 4
  5. 5. A. Rickettsialpox (R. akari)Correct ChoiceB. Rocky Mountain Spotted Fever (R. rickettsii)C. Epidemic typhus (R. prowazekii)D. Mediterranean fever (R. conorii)E. Endemic typhus (R. typhi)Rickettsia are short, gram-negative rods which are strict intracellular parasites. The bacteria istransmitted via tick which much be attached for more than 6 hours. The Weil-Felix test exploitscross-reactivity between the Proteus vulgaris antigen and RIckettsia17) A pool worker develops these painful erythematous nodules with ulceration on his fingers andthen his arms. The antibiotic of choice to treat this infection is:A. CeftriaxoneB. Trimethoprim-sulfamethoxasoleC. MinocyclineCorrect ChoiceD. DapsoneE. PenicillinSporotrichoid spread may be seen in cutaneous leishmaniasis, actinomycosis, atypical mycobacterialinfections, deep fungal infection, and melanoma. Mycobacterium marinum is associated with skininjury followed by exposure to contaminated water, usually from an aquarium, lake, or pool. Thetreatment of choice for M. marinum infections is minocycline18) A 20-month old child develops a high fever followed 2 days later by a sudden eruption of rosepink macules and papules with white halos as the fever subsides. What is the most likely diagnosis?A. MeaslesB. RubellaC. Exanthem Subitum Correct ChoiceD. Erythema infectiosumE. Scarlet feverThe cutaneous features of Exanthem Subitum (Roseola infantum, Sixth Disease)as described in thequestion develop as the fever subsides. While the other diagnoses are part of the differentialdiagnosis of "fever and rash" in children, only roseola infantum has this characteristic clinical course19) WHO recommendations for the treatment of multibacillary leprosy include all of the followingEXCEPT:A. ClofazimineB. All of these answers are recommended for the treatment of multibacillary leprosy.C. RifampinD. DapsoneE. ClarithromycinCorrect ChoiceClarithromycin is not part of the WHO recommendations for the treatment of multibacillary leprosy 5
  6. 6. 20) The most likely cause of the childhood infection shown is:A. E. coliB. Pseudomonas AeruginosaC. Group A Streptococcus Correct ChoiceD. S. AureusE. H. influenzaThis is an example of perianal streptococcal “cellulitis.” The causative organism is Group Astreptococcus21) In addition to Kaposi’s sarcoma, HHV-8 infection is also the causative agent in:A. Pyogenic granulomaB. Pityriasis roseaC. AngiosarcomaD. Primary effusion lymphomaCorrect ChoiceE. Bacillary angiomatosisHuman herpes virus 8 is a double stranded DNA virus. It is thought to be pathogenic in Kaposi’ssarcoma, primary effusion lymphoma, and Castleman’s disease. Primary effusion lymphoma is arare B-cell lymphoma seen predominantly in patients with AIDS22) The nonvenereal treponematosis shown is caused by which of the following organisms?A. T. pertenueB. T. pallidum (subsp. endemicum)C. B. duttoniiD. T. carateum Correct ChoiceE. T. pallidumThe depigmented patches on the hands shown are characteristic of the late (tertiary) stage of pinta.The causative organism is T. carateum23) A 52 year-old butcher presents with a tender lesion on his left hand as shown. The treatment ofchoice for this condition is:A. ChloramphenicolB. CiprofloxacinC. TetracyclineD. Penicillin Correct ChoiceE. AzithromycinThe clinical description and lesion shown in the image suggest a diagnosis of erysipeloid, caused byErysipelothrix rhusiopathiae. The treatment of choice is penicillin24) The treatment of choice of cat-scratch disease is: 6
  7. 7. A. ItraconazoleB. MebendazoleC. CeftriaxoneD. Trimethoprim-sulfamethoxazoleE. ErythromycinCorrect ChoiceCat-scratch disease is caused by Bartonella henselae, which is spread among cats by fleas. Thehallmark of the disease is unilateral and regional lymphadenopathy. The treatment of choice for cat-scratch disease is erythromycin25) Pretibial fever is caused by:A. ListeriosisB. Rickettsiae spp.C. LeptospirosisCorrect ChoiceD. Rickettsiae spp.E. EhlichiosisLeptospira autumnalis causes pretibial fever (“Fort Bragg fever” or anicteric leptospirosis), an acuteexanthematous infectious erythema, generally most prominent on the shins. Leptospira interrogans,serotype icterohaemorrhagiae, is the most common cause of Weil’s disease or icteric leptospirosis26) Guarneri bodies are associated with:A. Smallpox Correct ChoiceB. AnthraxC. MeaslesD. OrfE. CMVGuarnieri’s bodies are cytoplasmic eosinophillic inclusions found on light microscopy27) Petechial lesions at the junction of the hard and soft palate are characteristically seen in whichdisease?A. Kawasaki’s diseaseB. Infectious mononucleosisCorrect ChoiceC. Scarlet feverD. Rocky Mountain spotted FeverE. Rickettsialpox infectionForsheimer spots are distinctive pinhead size petechiae found at the junction of the hard and softpalate. They may be seen in infectious mononucleosis28) Congenital Varicella Syndrome occurs after maternal varicella infection during which stage ofpregnancy?A. Third trimester 7
  8. 8. B. First 20 weeks Correct ChoiceC. 20-24 weeksD. 5 days before and 2 days after deliveryE. None of these answers are correctCongenital Varicella Syndrome occurs after maternal varicella-zoster virus infection early inpregnancy (up to 20 weeks gestation)29) Of the choices listed, which antiobiotic is the best to treat a 7-year old child with erythemamigrans?A. TetracyclineB. AzithromycinC. AmoxicillinCorrect ChoiceD. DoxycyclineE. RifampinDoxycycline is the usual treatment for erythema migrans in adults in the absence of neurologic orcardiovascular complications. In children less than 8, all tetracyclines are relatively contraindicatedbecause of they can cause tooth discoloration. Therefore amoxicillin should be used as the first linetherapy for children less than 8. Note: Changes have been made to the treatment of RMSF. Childrenof any age should be treated with doxycycline for that disease30) A 48 year-old woman presents to the Emergency Room with a 2 day history of fever and a welldemarcated erythematous plaque on her right cheek. What is the treatment of choice?A. Potent topical corticosteroidB. FluconazoleC. Intravenous penicillinCorrect ChoiceD. PrednisoneE. CephelexinThe most likely diagnosis is Erysipelas which is caused by beta-hemolytic group A streptococcus.The treatment of choice is intravenous penicillin31) Herpes simplex virus infection and this condition has been linked to which HLA type?A. HLA B15Correct ChoiceB. HLA B51C. HLA DR3D. HLA Cw6E. HLA B27HSV related erythema multiforme has been associated with an increased frequency of HLA-B1532) Milker’s nodule is caused by infection with which of the following viruses?A. Orf virus 8
  9. 9. B. Human herpesvirus-8 (HHV-8)C. Paravaccinia virusCorrect ChoiceD. Human herpesvirus-6 (HHV-6)E. Vaccinia virusMilker’s nodule is caused by paravaccinia virus, a poxvirus of the genus Parapoxvirus. It istransmitted to humans from infected cows33) Which porphyrin is responsible for the fluorescence under Woods lamp examination oferythrasma?A. Protoporphyrin IXB. PorphobilinogenC. Coproporphyrin IIICorrect ChoiceD. CoproporphyrinogenE. UroporphobilinogenErythrasma is caused by corynebacterium minutissimum. The presence of coprophyrinogen IIIcreated by the bacteria is responsible for the characteristic coral-red fluorescence under Woodslamp34) Epithelioma cuniculatum is an HPV-associated verrucous carcinoma involving the:A. TrunkB. ScalpC. PenisD. Oral mucosaE. SoleCorrect ChoiceEpithelioma cuniculatum is a form of verrucous carcinoma involving the sole35) A 28 year-old man presents with fever, chills, arthralgias and the cutaneous lesions shown. Themost likely diagnosis is:A. Gonoccemia Correct ChoiceB. RickettsialpoxC. Primary herpes simplex infectionD. AnthraxE. Purpura fulminansThe image shows sparsely distributed hemorrhagic vesiculopustules with erythematous bases on anacral surface. These features are characteristic of gonococcemia36) Blueberry Muffin Baby can be a feature of all of the following EXCEPT:A. RhabdomyosarcomaB. Langerhans’ cell histiocytosis 9
  10. 10. C. TORCHD. Hemolytic disease of the newbornE. Klippel-Trenaunay-Weber syndrome Correct ChoiceBlueberry muffin lesions can be seen in the setting of prenatal infections (e.g. TORCH), severeanemia (e.g. Hemolytic Disease of the newborn) and neoplastic diseases (e.g. rhabdomyosarcoma).It is not associated with the Klippel-Trenaunay-Weber syndrome37) The treatment of choice for Oroya Fever is:A. ChloramphenicolCorrect ChoiceB. ErythromycinC. PenicillinD. MinocyclineE. DoxycyclineThe treatment of choice for Oroya Fever is chloramphenicolbecause of frequent superinfection withSalmonella38) A 10 year-old with a 3-day history of fever and headache presents to the clinic with multipleerythematous papulopustules on his extremities, many of which have central eschars. The mostlikely diagnosis is:A. ErlichiosisB. RickettsialpoxCorrect ChoiceC. MeningococcemiaD. Lyme diseaseE. Rocky mountain spotted feverRickettsialpox is an acute febrile illness caused by the bacteria Rickettsia akari, a member of thespotted fever group. R. akari is transmitted by the house mouse mite, Liponyssus sangineus.Clinically, patients have an eschar at the inoculation site with a subsequent papulovesicular rash,fevers, headache, chills, diaphoresis, myalgia, and anorexia39) A 35 year-old woman presents with a painful vaginal erosion and tender left-sided inguinallymphadenopathy. Gram stain reveals clusters of coccobacilli in a “school of fish” pattern. What isthe most likely diagnosis?A. Granuloma inguinaleB. ChancroidCorrect ChoiceC. Primary syphilisD. Secondary syphilisE. Lymphogranuloma venereumChancroid classically presents with a soft, tender chancre with ragged edges and unilateral, tenderinguinal adenopathy (bubo). A “school of fish” pattern on Gram or Giemsa stain is diagnostic40) All of the following are features of scarlet fever except: 10
  11. 11. A. S. aureus infectionCorrect ChoiceB. Pastia’s linesC. PharyngitisD. Circumoral pallorE. Sandpaper-like textureScarlet fever is primarily a disease of children with most cases occurring between the ages of 1 and10 years of age. Streptococcus pyogenes is the causative organism. It produces the streptococcuspyrogenic exotoxin which elicits the cutaneous manifestations by enhancing delayed typehypersensitivity to streptococcal products. Clinical findings include fever, sore throat, headache,chills, sandpaper rash on the trunks, strawberry tongue, and Pastia’s lines (linear petechial streaksfound in flexural locations41) Hebra nose deformity is characteristic of infection with which organism?A. Serratia marcesensB. Haemophilus influenzaeC. Streptococcus pyogenesD. E. coliE. Klebsiella pneumoniaeCorrect ChoiceHebra nose deformity is seen in Rhinoscleroma which is caused by Klebsiella pneumoniae42) Pediculus humanus corporis can transmit:A. Scrub typhusB. Oriental typhusC. Epidemic typhusCorrect ChoiceD. Endemic typhusE. Murine typhusThe body louse or Pediculus humanus corporis transmits Rickettsia prowasekii the organismresponsible for epidemic typhus. Endemic typhus or murine typhus is caused by R. typhi that istransmited by the rat flea/Xenopsylla cheopis. Scrub typhus is caused by R. tsutsugamushi and istransmitted by chiggers or trombiculid mite larvae43) Xenopsylla cheopis transmits:A. Rickettsia akariB. Epidemic typhusC. Scrub typhusD. Murine typhusCorrect ChoiceE. Rickettsia prowazekiiXenopsylla cheopis along with Ctenocephalides felis are fleas that transmit R. typhi, the organismresponsible for murine or endemic typhus. The body louse or Pediculus humanus corporis transmitsRickettsia prowasekii the organism responsible for epidemic typhus. Scrub typhus is caused by R.tsutsugamushi and is transmitted by chiggers or trombiculid mite larvae 11
  12. 12. 44) A 4 year-old boy is diagnosed with Staphylococcal Scalded-Skin Syndrome. Vesiculation in thisdisease is secondary to exfoliative toxins binding what target protein?A. Desmoglein 1Correct ChoiceB. Bullous Pemphigoid antigen 1C. Bullous pemphigoid antigen 2D. Desmoglein 3E. PlectinStaphylococcus Scalded-Skin Syndrome (SSSS) is caused by Staphylococcus exfoliative toxins Aand B binding desmoglein A. This results in the intraepidermal split at the granular layer seen in thisillness. Targeting of desmoglein 3 would result in a suprabasilar split. Targetting of plectin, BPAG1,or BPAG2 would result in a subepidermal split. This is not seen in SSSS45) Streptococcus Iniae has been shown to cause:A. Perianal dermatitis in neonatesB. Bullous impetigoC. Perineal erysipelas in postpartum womenD. Necrotizing fasciitisE. Hand cellulitis in fish handlersCorrect ChoiceStreptococcus iniae has been demonstrated to cause hand cellulitis from puncture wounds sustainedform the dorsal fin, fish bone or knife of usually a tilapia. Treatment with PCN is curative. Group AStreptococci are the most common cause of perianal dermatitis. Many different bacteria have beenimplicated in necrotizing fasciitis. Bullous impetigo is most frequently caused by phage type 71 S.aureus or a related group 2 phage type. Group B streptococcus is most often responsible forperineal erysipelas in postpartum women.46) What is the most common site of infection from Streptococcus Iniae?A. FaceB. HandCorrect ChoiceC. Lower legD. FootE. NailsStreptococcus iniae most commonly causes bacteremic cellulitis of the hand in persons who haverecently handled fresh fish. S. iniae is a fish pathogen that causes sporadic infection in tilapia,yellowtail, rainbow trout, and coho salmon. Treatment of choice is with penicillin antibiotics47) The vector of New World Leishmaniasis is the:A. Deer fly (Chrysops spp.)B. Tsteste flyC. Phlebotomus sandflyD. Lutzomyia sandflyCorrect ChoiceE. Simulium black fly 12
  13. 13. The sandfly belonging to the genus Lutzomyia is the vector of New World Leishmaniasis. Sandfliesof the genus Phlebotomus are the vectors of Old World Leishmaniasis48) How long is the life cycle for the mite that causes this infestation?A. 1 dayB. 1 monthCorrect ChoiceC. 6 monthsD. 1 yearE. 1 weekScabies is caused by the mite Sarcoptes scabiei var. hominis. The life cycle of the mite is 30 days. Afemale mite will lay 60-90 eggs during her life49) Herpes-associated erythema mutliforme is most commonly associated with which HLA type?A. HLA DR2B. HLA DR3C. HLA B15Correct ChoiceD. HLA B8E. HLA B27Recurrent erythema multiforme (EM minor) is usually caused by recurrent herpes simplex, mostcommonly HSV-1 orolabial disease. This is more correctly now called herpes-associated erythemamultiforme(HAEM) and has been more commonly associated with people with HLA type B1550) All of the following are features of the Ramsay Hunt Syndrome EXCEPT:A. Infection of the geniculate ganglionB. Vesicles on the external earC. TinnitusD. Facial paresisE. Herpes simplex infectionCorrect ChoiceRamsay Hunt syndrome results from varicella zoster virus infection of the geniculate ganglion of theseventh cranial nerve (CN VII). It is characterized by vesicles on the external ear or ear canal,tinnitus and/or other auditory symptoms, and ipsilateral facial paresis51) Exanthem Subitum is caused by which of the following?A. Group A SteptococcusB. Coxsackie virusC. Human Herpes Virus-6 (HHV-6) Correct ChoiceD. Parvovirus B19E. Epstein-Barr VirusExanthem Subitum (Roseola Infantum, Sixth Disease) is caused by human herpesvirus 6, and 7(HHV-6, HHV-7 13
  14. 14. 52) Carrions disease is characterized by fevers, headaches and arthralgias and is accompanied bysevere hemolytic anemia. Superinfection with which organism is the most frequent cause of death?A. ShigellaB. Bartonella henselaeC. SalmonellaCorrect ChoiceD. Bartonella bacilliformisE. Bartonella QuintanaCarrions disease (Oroya fever) is characterized by fevers, headaches and arthralgias and isaccompanied by severe hemolytic anemia. Superinfection with Salmonella is the most frequentcause of death. Protection from sandfly bites is all-important53) Dracunculiasis is typically acquired from:A. SoilB. Salt waterC. Black fliesD. Drinking water Correct ChoiceE. ChiggersDracunculiasis, which is caused by Dracunculus medinensis, is acquired by ingestion of copepod-infested water54) Which subtype of the human papilloma virus is most likely to have caused this infection?A. HPV, type 3B. HPV, type 6Correct ChoiceC. HPV, type 1D. HPV, type 5E. HPV, type 2The human papilloma virus is a member of the Papovavirus family, a double-stranded DNA virus.HPV, type 6 has been implicated in giant conduloma of Buschke and Lowenstein and anogenitalcondyloma55) Which of the following diseases is caused by a virus?A. Boutonneuse spotted feverB. Colorado tick feverCorrect ChoiceC. Q feverD. Rocky Mountain spotted feverE. Human monicytic ehrlichiosisRocky Mountain spotted fever is caused by Rickettsia rickettsii. Human monicytic ehrlichiosis iscaused by Ehrlichia chaffeensis. Colorado tick fever is caused by Reoviiridae. Boutonneuse fever iscaused by Rickettsia conorii. Q fever is caused by Coxiella burnetti 14
  15. 15. 56) Epidermodysplasia verruciformis is caused by which human papilloma virus (HPV) types?A. 3 and 10B. 6 and 11C. 5, 8, and 9Correct ChoiceD. 13 and 32E. 16 and 18Epidermodysplasia verruciformis is caused by HPV types 5, 8, 9, 12, 14, 15, 17, 19-2657) Verruga peruana is transmitted by:A. Fecal oral contactB. BlackflyC. SandflyCorrect ChoiceD. TickE. Fecal fecal contactVerruga peruana, a disease endemic to Peru and a few neighboring countries, is caused byBartonella bacilliformis. It is transmitted by the sandfly, Lutzomyia verrucarum. It is preceded by anacute febrile stage called Oroyo fever or Carrion’s disease. The treatment of choice ischloramphenicol58) Each of the following is true regarding leishmaniasis except:A. Arthropod vector is the sand flyB. Mazzotti’s test is diagnosticCorrect ChoiceC. Cutaneous disease is the most common formD. Pentavalent antimony used for visceral diseaseE. Espundia seen mucocutaneous diseaseLeishmaniasis is a parasitic infection born by a sandfly vector. No treatment is necessary forcutaneous leishmaniasis, pentavalent antimony for visceral leishmaniasis. Mazzotti reaction is usedto test for onchocerciasis in which a single dose of dimethycarbamazine is given for reaction59) What is the principal vector of Lyme Disease in the Northeastern U.S.?A. Lxodes ricinusB. Dermacentor variabilisC. Lxodes damminiCorrect ChoiceD. Ambylomma americanumE. Soft-bodied ticks (Ornithodoros)The proncipal vector of Lyme Disease in the Northeastern U.S. is Ixodes dammini (Ixodes scapularis60) Which of the following mycobacterial organisms is classified as a photochromogen? 15
  16. 16. A. M. tuberculosisB. M. grodonaeC. M. KansasiiCorrect ChoiceD. M. ulceransE. M. fortuitumM. Kansasii, M. marinum, and M. simiae are photochromogens. They form pigment when exposed tolight61) The vector of Trench Fever is the:A. Cat flea (Ctenocephalides felis)B. Human body louse (Pediculus humanus corporis)Correct ChoiceC. Trombiculid miteD. Sandfly (Phlebotamus perniciosus)E. Rat flea (Xenopsylla cheopis)The human body louse (Pediculus humanus corporis)is the vector of Trench Fever, Epidemic Typhus,and Relapsing Fever62) Pediculus humanus var. corporis (human body louse) is the vector in which of the followingdiseases:A. Q fever (C. burnetii)B. Endemic typhus (R. typhus)C. Rickettsialpox (R. akari)D. Epidemic typhus (R. prowazekii)Correct ChoiceE. Rocky Mountain Spotted Fever (R. rickettsii)The human body louse is the implicated Trench fever, epidemic typhus, and relapsing fever. Trenchfever usually affects alcoholic men and is manifested by fevers. Treatment is with ceftriaxone,erythromycin, or doxycycline. Epidemic typhus is manifested by fevers, chills, malaise, and a pinkmacular eruption beginning in the axilla and trunk. Treatment is with tetracycline orchloramphenicol. Relapsing fever is manifested by paroxysmal fevers, headache, lymphocytoma,and erythematous/petechial macules on trunk/extremities. Treatment is with doxycycline63) A 27 year-old man with a 1-month history of bilateral inguinal lymphadenopathy and a positive“groove sign.” What is the most likely diagnosis?A. GonorrheaB. Lymphogranuloma venereumCorrect ChoiceC. SyphilisD. ChancroidE. Herpes simplexInguinal adenopathy with fluctuant, tender nodes above and below Poupart’s ligament - referred toas “groove sign” - is a characteristic clinical feature of lymphogranuloma venereum 16
  17. 17. 64) The most common location of herpes gladiatorum is the:A. FaceCorrect ChoiceB. Anterior thighC. GroinD. HandE. ChestThe face is the most common location for Herpes Gladiatorum65) Which of the following is the vector of lymphatic filariasis caused by Wuchereria bancrofti?A. Black flyB. DeerflyC. Mosquito Correct ChoiceD. BotflyE. Tsteste flyLymphatic filariasis is spread by mosquitoes belonging to genera Aedes, Anopheles, Culex, orMansonia66) What is the classic CXR finding of a patient with inhalational anthrax?A. Pleural effusionsB. Increased interstitial markingsC. Widened mediastinumCorrect ChoiceD. Alveolar infiltratesE. Normal x-rayInhalation anthrax is the most lethal form of anthrax. Other forms include cutaneous anthrax and GIanthrax. The classic radiographic finding is a widened mediastinum67) What is the vector for this nematodal infection?A. Tsetse fly (Glossine morsitans)B. Mango fly (Chrysops)Correct ChoiceC. Black fly (Simulium)D. Water flea (Cyclops)E. Reduviid bugLoiasis is caused by the nematode loa loa. It is transmitted by the mango fly (Chrysops dimidia orCHrysops silacea). It may manifest with painful, localized subcutaneous nonpitting edema calledcalabar swellings. Conjunctival migrations are also common68) A goatherder develops this painless pustule that subsequently forms a black eschar. Whatcauses the edema to form in this lesion? 17
  18. 18. A. Inhibition of phagocytosisB. C1 esterase inhibitorC. Increased levels of cAMPCorrect ChoiceD. Release of TNF-alphaE. Release of IL-1betaAnthrax is caused by Bacillus anthracis, a gram positive spore-forming rod. Anthrax is primarilyseen in individuals who are in contact with wild or domestic animals. Recent cases have been linkedwith bioterrorism. B. anthracis produces edema toxin and lethal toxin. Edema toxin is comprised ofedema factor and protective antigen. Edema factor is a calmodulin dependent adenyl cyclase. Theincreased cAMP induces the gelatinous edema of anthrax skin lesions69) Which human papillo viurs (HPV) type is implicated in papillomatosis cutis carcinoides diGottron?A. 7B. 11Correct ChoiceC. 60D. 18E. 57Papillomatosis cutis carcinoides di Gottron, also know as Gottrons tumor, is a verrucous carcinomaof the skin. In 1948, Ackerman first described verrucous carcinoma (VC), a low-grade tumor thatgenerally is considered a clinicopathologic variant of squamous cell carcinoma.Verrucous carcinomas are caused by HPV types 6 and 11. When they occur on the feet they arecalled epithelioma caniculatum. When they occur on the genitals they are refered to as Buschke-Lowenstein tumors. When they occur in the mouth they are called Ackermans tumors or oral floridpapillomatosis70) A 48 year-old man develops headache, myalgias, and high fever 5 days after a hunting trip. Onexamination he has a tender ulcer with raised margins and an eschar on his index finger, as well astender axillary lymphadenopathy. The most likely diagnosis is:A. OrfB. AnthraxC. Tularemia Correct ChoiceD. GlandersE. ErysipeloidTularemia, which is caused by Francisella tularensis, occurs after exposure to infected animals,including, rabbits, foxes, and squirrels. The clinical description is that of the ulceroglandular form,which is the most common presentation71) Which exotoxin(s) are involved in mediating the effects of Bacillus anthracis - the causativeorganism for anthrax?A. Lethal ToxinB. Edema Toxin and Lethal ToxinCorrect ChoiceC. Exotoxin B 18
  19. 19. D. Edema ToxinE. Alpha toxinB. anthracis has 2 exotoxins: edema toxin and lethal toxin, each comprised of a pair ofnoncovalently linkedproteins:– Edema toxin = Edema Factor (EF) + Protective Antigen (PA)– Lethal toxin = Lethal Factor (LF) + PA– EF causes gelatinous edema of anthrax skin lesions by inducing an increase in cyclic adenosinemonophosphate (cAMP) levels– LF causes shock and death in disseminated anthrax via the release of tumor necrosis factor-alpha(TNF-a)and interleukin-1b (IL-1b)– PA is responsible for entry of exotoxins into the cell by receptor-mediated endocytosis72) A 43 year-old man with uncontrolled HIV disease presents with yellowish, red papules, drainingsinuses and ulcers perianally and periurethrally. Which histopathological or immunohistochemicalstain may aid in diagnosis?A. Von Gieson (EVG)B. CD3C. SteinerD. CD20E. Von KossaCorrect ChoiceThe most likely diagnosis is malakoplakia. Malakoplakia, an infection usually attributed to S. aureus,P. aeruginosa, or E. coli is characterized histopathologically by Michelis-Gutmann bodies. These arefoamy eosinophilic macrophages containing calcified, laminated, intracytoplasmic bodies. They canbe highlighted by a calcium stain such as von Kossa. CD3 and CD20 are lymphocyte markers, vonGieson is an elastic tissue stain, and Steiner stain is used to highlight spirochetes. These would notaid in the diagnosis of malakoplakia73) A 42 year-old woman presents with a large, vegetating ulcer involving her left labia majora andgroin for over 1 year. A Giemsa’s stained touch preparation reveals bipolar, safety pin-shapedintracytoplasmic inclusions. What is the most likely diagnosis?A. ChancroidB. Lymphogranuloma venereumC. GonorrheaD. Primary herpes simplexE. Granuloma InguinaleCorrect ChoiceBipolar, safety pin-shaped intracytoplasmic inclusions on Giemsa stain - known as Donovan bodies -are diagnostic of granuloma inguinale74) The leading infectious cause of deafness and mental retardation in the U.S. is:A. Congenital herpes simplexB. Congenital syphilisC. Congenital Cytomegalovirus (CMV)Correct ChoiceD. Congenital varicella 19
  20. 20. E. Congenital RubellaCongenital CMV is the leading infectious cause of deafness and mental retardation in the U.S.75) Which human papillomavirus type is associated with giant condylomata of Bushke andLowenstein (Bushke-Lowenstein tumor)?A. 2B. 31C. 16D. 1E. 6 Correct ChoiceThe Bushke-Lowenstein tumor is caused by HPV-6 and 1176) Each of the following species may be involved in necrotizing fasciitis except:A. MycobacteriumCorrect ChoiceB. PseudomonasC. BacteroidesD. StreptococcusE. ClostridiumNecrotizing fasciitis is a rapidly advancing acute necrotizing infection that may follow trauma,surgery, or occur spontaneously. It is associated with systemic toxicity and high mortality rate.Clinically, erythema, edema, and edema progresses to dusky cyanosis, blistering and necrosis.Many virulent bacteria have been culturesd including Pseudomonas, Bacteroides, streptococci,staphylococcus, enterococci, and clostridium. Both aerobic and anaerobic cultures should be taken.Mycobacterium is not associated with necrotizing fasciitis77) Bacillary angiomatosis is caused by which of the following organisms?A. B. quintanaB. All of these answers are correctC. B. quintana and B. henselaeCorrect ChoiceD. B. bacilliformisE. B. henselaeB. quintana or B. henselae are both causative organisms for bacillary angiomatosis78) A 24 year-old man from New York City develops fever, chills, malaise, and a severe headache.His apartment has a mouse problem. On examination, multiple, discrete papulovesicles and a singleeschar are found. What is the most likely diagnosis?A. RickettsialpoxCorrect ChoiceB. Rocky Mountain Spotted FeverC. Q FeverD. Meningococcemia 20
  21. 21. E. EhrlichiosisThe clinical description is that of rickettsialpox, which is caused by R. akari and spread byliponyssoides sanguineus - the house mouse mite79) Nonmenstrual cases of the staphylococcal toxic shock syndrome are mediated by which of thefollowing toxins?A. Epidermolytic toxins A and BB. Edema toxinC. Pyrogenic exotoxins A, B, CD. Exfoliative toxins A and BE. Enterotoxins B and C Correct ChoiceToxic shock syndrome (TSS) is mediated by Enterotoxins B and C (50% of nonmenstrual cases) andTSS toxin 1 (TSST-1), which is the leading cause of menstrual cases80) A 27 year-old HIV positive presents with this pruritic eruption? What is the characteristic celltype found on histopathology?A. Plasma CellB. LymphocyteC. NeutrophilD. EosinophilCorrect ChoiceE. NeutrophilEosinophilic pustular folliculitis is a pruritic disorder that may be seen in HIV positive patients.Typically, the CD4 count is < 300. In patients with HIV, pruritus tends to improve after institution ofanti-retroviral therapy81) Which of the following statements best describes the pathogenesis of scrofuloderma?A. Autoinoculation of M. tuberculosis from advanced pulmonary tuberculosisB. Hematogenous spread of M. tuberculosis from a distant site of infectionC. Primary incoculation of M. tuberculosis in a sensitized hostD. An cutaneous manifestation of military tuberculosisE. Contiguous spread from an underlying focus of tuberculous lymphadenitis Correct ChoiceScrofuloderma is the result of contiguous spread onto skin from an underlying focus of tuberculousinfection. This typically occurs in a sensitized host with low immunity82) Focal epithelial hyperplasia (Heck’s Disease) is associated with which of the following humanpapillomavirus types?A. 7B. 13 Correct ChoiceC. 10D. 4 21
  22. 22. E. 3Focal epithelial hyperplasia is caused by HPV-13 and 3283) Winterbottom’s sign is a characteristic feature of which of the following diseases?A. OnchocerciasisB. LeishmaniasisC. LoaiasisD. StrongyloidiasisE. African Trypanosomiasis Correct ChoiceWinterbottom’s sign (posterior cervical lymphadenopathy) is a clinical feature of Africantrypanosomiasis. Romaña’s sign (eyelid edema and conjunctivitis at site of incoculation) is adiagnostic finding in American trypanosomiasis (Chagas’ disease)84) A young patient presents to you after participating in a bar brawl a few nights before with apainful swollen erythematous right hand. The most likely organism is:A. Staphylococus aureusB. Bacteriodes fragilisC. Eikenella corrodensCorrect ChoiceD. Pasturella multocidaE. Streptococcus pyogenesEikenella corrodens is a member of normal oral flora, that is commonly the cause of human bite andfist fight infections. Pasturella multocida is a common organism found in dog and cat bites. Staphand Strep could be the right answers for a cellulitis, but with this history are not the correct choices.Baceriodes fragilis is found in normal bowel flora85) Hutchinson’s teeth are a feature of which stage of syphilis?A. PrimaryB. SecondaryC. TertiaryD. Early congenitalE. Late congenital Correct ChoiceHutchinson’s teeth (widely-spaced, peg-shaped upper incisors) are a seen in Late CongenitalSyphilis (> 2 years of age86) The causative organism in Whitmore disease is which of the following?A. Vibrio vulnificusB. Pseudomonas aeruginosaC. Streptobacillus moniliformisD. Burkholderia pseudomalleiCorrect ChoiceE. Klebsiella pneumoniae 22
  23. 23. Whitmore disease also known as Meloidosis is characterized by pulmonary disease, septicemia, andmiliary abscesses. It is caused by Burkholderia pseudomallei87) All of the following are true regarding tularemia except:A. Potential for use as a biologic weaponB. Ticks serve as a reservoirC. No longer one of the CDCs list of reportable diseasesCorrect ChoiceD. Presents as an acute febrile illnessE. Caused by the gram negative Francisella tularensisTularemia is a zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis. Itis transmitted by arthropods (particularly tick bites) or from contact with infected mammals (usuallyrabbits). It characteristically presents as an acute febrile illness with other variable clinicalmanifestations depending on the route of inoculation. Possible symptoms could include an ulcer atthe site of inoculation, pharyngitis, ocular lesions, lymphadenopathy, and pneumonia. Diagnosis canbe made by culture or a fourfold titer change. Because of its potential use as a biologic agent,tularemia is once again a reportable disease88) All of the following are potential causes of a false positive RPR except:A. PregnancyB. MalariaC. Malignant MelanomaCorrect ChoiceD. Systemic Lupus Erythematosus (SLE)E. Lepromatous LeprosyNon-treponemal tests for syphilis measure antibodies against phospholipids released fromtreponemes and damaged host cells. False positive non-treponemal tests can occur in the setting ofpregnancy, autoimmune diseases, other spirochete infections, and infectious diseases such asleprosy and malaria. It does not occur in cases of melanoma89) Coxsackievirus A16 is implicated in the pathogenesis of which of the following dieases?A. Fifth diseaseB. Exanthem subitumC. Papular purpuric “gloves and socks” syndromeD. Hand-Foot-and-Mouth disease Correct ChoiceE. Erythema infectiousumHand-Foot-and-Mouth disease is caused by coxsackievirus A16. Group A coxsackievirus infection isalso associated with herpangina90) The most common bacterial cause of purpura fulminans is:A. Group A streptococcus Correct ChoiceB. E. coliC. P. aeruginosa 23
  24. 24. D. S. aureusE. H. influenzaeGroup A streptococcus is the leading bacterial cause of purpura fulminans91) Which of the following is the causative organism of Tularemia?A. Orientia tsutsugamushiB. Klebsiella pneumoniaeC. Burkholderia malleiD. Francisella tularensisCorrect ChoiceE. Streptobacillus moniliformisTularemia is caused by infection with Francisella tularensis - most commonly acquired after contactwith infected rabbits (e.g. hunters92) Roseola infantum is caused by which virus?A. Pox virusB. Coxsackie virus A16C. Parvovirus B19D. Human herpes virus 6Correct ChoiceE. Epstein-Barr virusRoseola infantum may be cause be either human herpes virus types 6 or 7. It is the sixth of thetraditional exanthems of childhood. A diffuse, maculopapular eruption is typically preceded by aprodrome of fever and either respiratory or gastrointestinal symptoms. The infection usually occursin the spring and the fall and nearly all children are seropositive for the virus by the age of 493) Foamy macrophages containing Klebsiella pneumoniae are called:A. Mikuliczs cellsCorrect ChoiceB. Virchow cellsC. Michaelis-Gutman cellsD. Russell cellsE. Hansemanns cellsMikulicz’s cells are foamy macrophages found in Rhinoscleroma – a chronic, inflammatory,granulomatous disease of the upper respiratory tract. Virchow cells are found in Hansen’s disease.Hansemann cells and Michaelis-Gutman bodies are found in Malakoplakia94) The diagnosis of leishmaniasis can be confirmed by which of the following techniques?A. Culture in Sabourads agarB. Warthin-Starry stainC. Culture in Michels mediumD. Weil-Felix test 24
  25. 25. E. Culture in Novy-MacNeal-Nicolle (NNN) mediumCorrect ChoiceConfirmation of infection with Leishmaniasis is performed by culture in Novy-MacNeal-Nicolle (NNN)medium95) What is the most common cause of focal epithelial hyperplasia?A. Pachyonychia CongenitaB. human immunodeficiency virus(HIV)C. Dyskeratosis CongenitaD. human papilloma virus(HPV)Correct ChoiceE. Ebstein Bar virus(EBV)Focal epithelia hyperplasia, also known as Hecks disease, is caused by HPV types 13, 32 and 57. Itis most commonly found on the lower lip but also on the buccal mucosa, gums and tongue. It ismainly a disease of native Americans and Greenlander Eskimos. EBV causes an oral hairyleukoplakia in patients with AIDS. Pachyonychia Congenita patients commonly develop a benign oralleukoplakia, while Dykeratosis Congenita patients develop a premalignant oral leukoplakia96) Which form of cutaneous tuberculosis is associated with the highest level of immunity?A. Tuberculosis gummaB. Tuberculosis verrucosa cutisC. Lupus vulgarisCorrect ChoiceD. Miliary tuberculosisE. Tuberculosis chancreLupus vulgaris is an chronic, progressive form which usually occurs around nose, neck and earlobes,notable for gelatinous "apple-jelly" hue. Tuberculosis chancre and tuberculosis verrucosa cutis cutisare primary inoculations of tuberculosis infection. Tuberculosis gumma and miliary tuberculosis areassociated with lowered states of immunity97) Which of the following is the causative organism of cat-scratch disease?A. B. quintanaB. B. burgdorferiC. B. bacilliformisD. B. henselae Correct ChoiceE. B. duttoniiB. henselae is the cause of cat-scratch disease. Humans are infected by a cat bite or scratch, whilethe cat flea is responsible for cat to cat transmission98) Herpangina is caused by which of the following?A. Parvovirus B19B. Group A coxsackievirusCorrect ChoiceC. Human Herpesvirus 6 (HHV-7) 25
  26. 26. D. Epstein Barr VirusE. Human Herpesvirus 6 (HHV-6)Herpangina is caused by Group A coxsackievirus99) A patient on the bone marrow transplant service has a fever, neutropenia, hemorrhagic bullaeand erythematous nodules with dusky gray centers. The organism most likely to be responsible is:A. Streptococcus pyogenesB. Pseudomonas aeruginosaCorrect ChoiceC. Mycobacterium tuberculosisD. Staphylococcus aureusE. Candida albicansEcthyma gangrenosum is an infection of critically ill or immunocompromised individuals byPseudomonas aeruginosa. Clinically, patients develop opalescent, tense vesicles or pustulessurrounded by a narrow pink to violaceous halo. The lesions rapidly become hemorrhagic, thenviolaceous and necrotic leaving ulcers. The most common location is on the buttocks and lowerextremities. Treatment is with aminoglycosides100) What is the treatment of choice in a penicillin allergic individual?A. RifampiinB. PenicillinC. DoxcycylineCorrect ChoiceD. CeftriaxoneE. ClindamycinSecondary syphillis is caused by the spirochete, T. pallidum. Penicillin is the treatment of choice forsecondary syphillis. In penicillin allergic individuals, doxycyline may be used101) A patient presents with this anesthestic plaque. Which cytokines are upregulated in thisdisease?A. IL-2Correct ChoiceB. All of these cytokines are upregulatedC. IL-5D. IL-10E. IL-4Leprosy is caused by infections to Mycobacterium leprae. It is a acid fast bacilli. In tuberculoidleprosy, Th1 cytokines (IL-2, IFN-gamma) are upregulated. Clinically, patients have few, well-circumscribed anesthetic plaques102) A 43 year-old man presents with suppurative nodules and sinus tracts over the mandible. Healso is noted to have poor oral hygiene. What is the most likely causative organism?A. Staphylococcus aureusB. Nocardia brasilensis 26
  27. 27. C. Streptococcus somaliensisD. Bartonella HenselaeE. Actinomyces israeliiCorrect ChoiceActinomyces israelii is an anaerobic gram-positive rod which causes chronic suppurative nodulesand sinus tracts with an exudate containing sulfur granules. It most commonly effects thecervicofacial area, especially near the mandible. The abdomen and thoracic areas can also beaffected. The source of infection is endogenous and patients with poor oral hygiene, penetratingforeign bodies, and recent dental procedures are at increased risk. Treatment of choice is penicillin103) A 32 year-old woman presents with meningitis and palpable purpura. A diagnosis ofmeningococcemia is confirmed via culture of cerebrospinal fluid. Which complement components aremost likely to be deficient in this patient?A. C3B. C2C. C4D. C5Correct ChoiceE. C1Patients with meningococcemia often demonstrate deficiencies of late complement componentsC5-9.104) A 62 year-old man presents with tinnitus, facial paralysis, and vesicles of the external ear.What is the most likely diagnosis?A. Primary Herpes Simplex infectionB. Coxsackievirus A16 infectionC. Cytomegalovirus infectionD. Primary Varicella InfectionE. Herpes Zoster InfectionCorrect ChoiceThis patient has Ramsay Hunt Syndrome, herpes zoster infection of the geniculate ganglion.Vesicles can be seen on the tympanic membrane and the external ear. Symptoms include ipsilateralfacial paralysis, tinnitus, or other auditory symptoms. Treatment is with acyclovir and systemiccorticosteroids105) Calabar swellings are a characteristic feature of which disease?A. EumycetomaB. LoiasisCorrect ChoiceC. Carrions DiseaseD. Tertiary SyphilisE. OnchocerciasisCalabar swellings are characteristic of Loiasis. They are transient, non-tender soft tissue swellingsfound most commonly around joints106) What is the characteristic body on histopathology for this disease? 27
  28. 28. A. Henderson-PattersonB. Cowdry Type ACorrect ChoiceC. DutcherD. GuarnieriE. Cowdry Type BHerpes simlex virus is characterized by Cowdry type A bodies on histopathology. They appear assharply demarcated eosinophilic structures separated by a clear halo from a basophilic rim of theinfected cells marginated nuclear chromatin. Cowdry B bodies may be seen in polio infections107) A 10 year-old girl presents to the dermatology clinic with a pruritic eruption on her trunk afterswimming at a beach in Florida. Of note, the lesions are limited to skin that was covered by herbathing suit. The most likely diagnosis is:A. Swimmer’s itchB. Cutaneous larva migransC. Cercarial dermatitisD. Seabather’s eruption Correct ChoiceE. Swimming pool granulomaSeabather’s eruption characteristically involves areas covered by swimwear, as a result ofcoelenterate larvae becoming trapped underneath bathing suits. The causative organisms are larvalforms of Edwardsiella lineata (sea anemone) and Linuche unquiculata (thimble jellyfish).108) The Jarisch-Herxeimer reaction is most closely associated with the release of which of thefollowing cytokines?A. IFN-alphaB. IL-10C. IL-12D. IL-4E. TNF-alpha Correct ChoiceTNF-alpha. The Jarisch-Herxheimer reaction is associated with increased plasma concentrations ofTNF-alpha after antibiotic treatment of syphilis. The Jarisch-Herxheimer reaction has also beendescribed following treatment of louse-borne relapsing fever, lyme disease and leptospirosis109) The causative organism of epidemic typhus is:A. Salmonella typhiB. R. prowazekiiCorrect ChoiceC. Francisella tularensisD. R. typhiE. R. akariEpidemic typhus is caused by infection with R. prowazekii 28
  29. 29. 110) The expanding annular erythematous patch shown developed in a 25 year-old woman afterreturning from a weekend at her summer home in Long Island, New York. The vector of thisinfection is:A. Lutzomyia verrucarumB. Ixodes dammini Correct ChoiceC. Ixodes ricinusD. Ctenocephalides felisE. Pediculus humanus corporisThis is an example of erythema migrans, seen in Lyme disease. Ixodes dammini is the principalvector in the northeastern U.S111) Streptobacillus moniliformis is the causative organism of which infectious disease?A. GlandersB. Rat-bite fever (Haverhill fever)Correct ChoiceC. TularemiaD. Cat scratch diseaseE. Scrub typhusRat-bite fever (Haverhill fever) is caused by Streptobacillus moniliformis112) Which antibiotic is best to treat this condition caused by Bartonella hensalae.A. CeftriaxoneB. ErythromycinCorrect ChoiceC. ClindamycinD. FluconazoleE. Trimethoprim/sulfamethoxasoleBartonella hensalae is the causative agent of bacillary angiomatosis. The differential diagnosis ofbacillary angiomatosis may include pyogenic granulomas and Kaposis sarcoma. The treatment ofchoice is erythromycin113) The treatment of choice of the tropical infectious disease shown is:A. IvermectinB. MebendazoleC. PermethrinD. Pentavalent antimony Correct ChoiceE. DiethylcarbamazineThe ulcerated nodule shown here is characteristic of cutaneous leishmaniasis (CL). Leishmaniasis istreated with pentavalent antimony114) Tick-borne Relapsing Fever is caused by: 29
  30. 30. A. B. duttoniiCorrect ChoiceB. B. henselaeC. B. burgdorferiD. B. recurrentisE. B. bacilliformisRelapsing Fever can be either Louse-borne or Tick-borne. Tick-borne Relapsing Fever is caused byB. duttonii, while Louse-borne Relapsing Fever is caused by B. recurrentis115) Cat scratch disease is caused by infection with:A. Bartonella speciesCorrect ChoiceB. Gram-positive bacilliC. SpirochetesD. RickettsiaeE. Gram-positive cocciCat scratch disease is caused by infection with B. henselae - a gram-negative bacillus of the genusBartonella116) Corynebacterium minuttissimum is responsible for which of the following infections?A. ErysipeloidB. Trichomycosis axillarisCorrect ChoiceC. Majocchis granulomaD. ErysipelasE. MalakoplakiaCorynebacterium minutissimum is responsible for causing trichomycosis axillaris, a superficialbacterial overgrowth of axillary hairs characterized by circumferential yellow (most common), red,or black granular concretions. Majocchis granuloma is a dermatophyte infection. Erysipelas iscaused by beta-hemolytic group A streptococcus. Malakoplakia is usually caused by S. aureus, P.aeruginosa, or E. coli. Erysipeloid is caused by Erysipelothrix rhusiopathiae. Corynebacterium is alsothe causative organism in erythrasma and pitted keratolysis117) Measles is caused by which type of virus?A. ParamyxovirusCorrect ChoiceB. TogavirusC. ParvovirusD. PicornavirusE. RhabdovirusMeasles is caused by an RNA virus known as paramyxovirus. The illness is characterized by highfever, cough, coryza, conjunctivitis, and Kopliks spots. Viral exanthem characterized byerythematous macules and papules beginning on the face and spreading caudally 3-4 days afterprodromal symptoms 30
  31. 31. 118) A 27 year-old woman who is 30 weeks pregnant presents with erythema migrans. Thetreatment of choice for this patient is:A. DoxycyclineB. AmoxicillinCorrect ChoiceC. ErythromycinD. ClindamycinE. ChloramphenicolIn the setting of pregnancy, amoxicillin is the treatment of choice for Lyme Disease sincedoxycycline is contraindicated119) The treatment of choice for Loiasis is:A. Diethylcarbamazine (DEC)Correct ChoiceB. PermethrinC. IvermectinD. MalathionE. ChloramphenicolThe recommended treatment for loiasis is Diethylcarbamazine (DEC120) The most likely target for exfoliative toxin A in bullous impetigo is:A. Desmoglein 1Correct ChoiceB. BPAG2C. BPAG1D. DesmocollinE. Desmoglein 3Bullous impetigo is caused primarily by staphylococcus aureus phage type 71. This bacteriaproduces exfoliative toxin A binds to desmoglein 1 and produces produces the blisters characteristicof bullous impetigo121) The infectious disease shown is most likely caused by which of the following organisms?A. L. mexicana complexB. L. infantumC. L. majorD. Klebsiella pneumoniae rhinoscleromatis Correct ChoiceE. L. donovaniThe figure is an example of rhinoscleroma, which is caused by Klebsiella pneumoniaerhinoscleromatis. While the diagnosis of mucocutaneous leishmaniasis (MCL) could be considered,none of the leismania species listed as possible responses are causes of MCL122) A 8 year-old girl presents to the pediatrician with a poorly marginated blue-red singleindurated plaque on her right cheek. What is the most likely causative organism? 31
  32. 32. A. Klebsiella pneumoniaeB. Staphyloccus aureusC. Beta-hemolytic group A streptococcusD. Haemophilus influenzaeCorrect ChoiceE. Pseudomonas aeruginosaThe most likely diagnosis is H. flu cellulitis. This infection usually occurs in children and ischaracterized by a single indurated plaque with poorly delineated margins. Erysipelas, an infectioncaused by beta-hemolytic streptococcus group A, usually presents with well delineated margins inadult patients123) A 35 year-old woman who works in the animal product industry presents with a painlesshemorrhagic bulla. A diagnosis of anthrax is suspected. Gram stain of the vesicle fluid should revealwhich of the following?A. Gram-negative cocciB. Guarnieri bodiesC. Gram-positive bacilli Correct ChoiceD. Gram-negative bacilliE. Gram-positive cocciAnthrax is caused by Bacillus anthracis, which is a gram-positive spore-forming rod124) The mechanism of action of this virulence factor of Bacillus anthracis is via increasing theactivity of tumor necrosis factor alpha:A. Lethal toxinCorrect ChoiceB. All of the above answers are correctC. Edema toxinD. Polyglutamate acid capsuleE. None of the above answers are correctBacillus anthracis is responsible for causing Anthrax. Anthrax of the skin is characterized by apainless edematous nodule which rapidly degenerates into an eschar. B. anthracis has 3 virulencefactors: a polyglutamate acid capsule which inhibits phagocytosis of the bacteria, edema toxin(edema factor and protective factor) which results in edema secondary to induction of cAMPpathway, and lethal toxin (lethal factor and protective factor) which leads to shock and death viaincreasing TNFalpha activity125) At what rate of speed does this parasite migrate through the skin?A. 0.1 cm/dayB. 10 cm/dayC. 1 cm/dayD. 2 cm/dayCorrect ChoiceE. 100 cm/day 32
  33. 33. The infection depicted is larva migrans or creeping eruption which is caused by Ancylostomabraziliense. This nematode is typically a hookworm of cats and dogs. It migrates at a rate of 2cm/day. Larva currens migrates at a rate of 10 cm/day126) High doses of which of the following antiviral agents has been associated with thromboticthrombocytopenic purpura in immunosuppressed patients?A. AcyclovirB. ValcyclovirCorrect ChoiceC. CidofovirD. FoscarnetE. FamciclovirThrombotic thrombocytopenic purpura has been reported with high doses of valcyclovir inimmunosuppressed patients127) Orf virus infection is also known as:A. EcthymaB. PseudocowpoxC. Ecthyma contagiosumCorrect ChoiceD. Milkers noduleE. Echtyma gangrenosumOrf virus infection is also known as Ecthyma contagiosum. Ecthyma Gangrenosum is caused byPseudomonas aeruginosa. Ecthyma is caused by Staphylococcal or streptococcal pyoderma.Pseudocowpox and Milkers nodule are also known as paravaccinia and caused by udders of infectedcows128) Botryomycosis is:A. An acute, disseminated infection involving the genitourinary systemB. A fungal infection caused by T. tonsuransC. A bacterial infection commonly associated with Staphylococcus aureusCorrect ChoiceD. A bacterial infection commonly associated with Clostridium botulinumE. A fungal infection caused by M. canisBotryomycosis is an uncommon, chronic, idonlent disorder characterized by nodular, crusted,purulent lesions. Sinuses that discharge sulfur granules are present. These heal with atrophic scars.The granules yield most commonly Staphylococcus aureus on culture, although cases caused byPseudomonas aeruginosa, E. coli, Proteus, Bacteroides, and Streptococcus have been reported129) Xenopsylla cheopis is the vector responsible for which infectious disease?A. Human Granulocytic EhrlichiosisB. Scrub typhusC. Endemic typhusCorrect ChoiceD. Human Monocytic Ehrlichiosis 33
  34. 34. E. Epidemic typhusXenopsylla cheopis (rat flea) is the vector of endemic typhus, which is caused by R. typhi130) Erythema infectiosum is caused by a:A. None of these answers are correctB. Single stranded DNA virusCorrect ChoiceC. Double stranded DNA virusD. RNA virusE. Herpes virusErythema infectiosum is caused by parvovirus B19 which is a single stranded DNA virus131) Which of the following vectors is responsible for transmitting Chagas’ disease?A. Reduviid bug Correct ChoiceB. SandflyC. Black flyD. Tstse flyE. MosquitoThe reduviid big is the vector of American trypanosomiasis (Chagas disease). The vector of Africantrypanosomiasis is the tstse fly132) All of the following statements are true of Bacillus anthracis infection except:A. inhalation, GI and cutaneous forms existB. ciprofloxacin and doxycycline are first line treatmentsC. Spores remain stable for decadesD. 20% mortality rate in untreated cutaneous infectionsCorrect ChoiceE. no recommendations from CDC exist on anthrax vaccineAnthrax can present in three different clinical forms: cutaneous, inhalational, and gastrointestinal.The cutaneous form appears as a painless vesicle that later forms an eschar (malignant pustule).The cutaneous form has a mortality rate of less than 1% if treated an up to 20% if untreated133) Which of the following is the vector responsible for the transmission of Verruga Peruana?A. Ctenocephalides felisB. Tsetse flyC. Lutzomyia verrucarumCorrect ChoiceD. Pediculus humanus corporisE. Simulium slossonaeVerruga Peruana is caused by infection with B. bacilliformis, which is transmitted by the sandfly,Lutzomyia verrucarum 34
  35. 35. 35