The document discusses several infectious diseases: 1. Malaria is caused by Plasmodium parasites and transmitted by Anopheles mosquitoes. Quinine is the drug of choice for resistant P. falciparum malaria. Diagnosis requires examination of thick and thin blood films. 2. Congenital toxoplasmosis has a 60% transmission rate from infected mothers to fetuses. Risk is highest in early pregnancy and third trimester. It can cause vision and brain issues at birth. 3. Lymphatic filariasis is caused by filarial worms and transmitted by mosquitoes. Higher worm loads and eosinophilia are linked to more severe symptoms. The document provides

1. INFECTIOUS DISEASE
1. Regarding Malaria
A. Caused by Plasmodium falciparum, P.vivax, P.ovale, and P.malariae.
B. Transmitted by the bite of male anopheline mosquitoes.
C. P.ovale is now resistant to chloroquine.
D. Quinine is the drug of choice.
E. Thick and thin blood films are required to diagnose.
2. Congenital Toxoplasmosis
A. There is 60% transmission rate to the fetus in pregnant women with toxoplasmosis.
B. Chance of transmission highest in early pregnancy.
C. Greatest chance of transmission in the third trimester.
D. Main features are retinochoroiditis, microcephaly and hydrocephalus.
E. Many fetal infections are subclinical at birth.
3. Lymphatic filiariasis
A. Vectors are Mansonia sp, Aedes sp and Anopheles sp.
B. Caused by filiarial worms which are Wuchereria bancrofti and Brugia malayi.
C. More adult worms, more microfiliarisis in the body.
D. Higher eosinophilia, more severe symptoms.
E. Tropical Pulmonary Eosinophilia (TPE) present in acute stage
4. HIV
A. There were 3 clinical stages.
B. Passive partners have more risk to get infected than active partners.
C. Most common transmission in Malaysia is through sharing needles.
D. The median interval from infection to the development of symptoms is around 7 to 10
years.
E. AIDS defined when HIV patient has PCP.
5. Clinical stages of HIV
A. PGL present at inguinal lymph nodes only.
B. Angular cheilitis is caused by iron deficiency.
C. Oral hairy leukoplakia present in clinical stage 3.
D. Pneumocystis pneumonia can preset with cyanosis.
E. Oral ulcers were diagnosed clinically.
6. Opportunistic infections
A. Esophageal candidiasis is treated with fluconazole.
B. Cryptococcal meningitis is one of the opportunistic infections.
C. Toxoplasmosis treated with pyrimethamine, clindamycin and folinic acid.
D. Usually occur in person that have CD4 count >500cells/mm3.
E. Penicillosis is treated with Amphotericin B.
7. Sexual transmitted diseases
A. Neisseria gonorrhoea is intracellular organism.

2. B. Urethral pus present in male with gonorrhoea infections.
C. ‘Clue cells’ seen in gonorrhoea.
D. White curds can be present in bacterial vaginosis.
E. Painless ulcer present in syphilis.
8. Typhoid fever
A. Caused by Salmonella typi and S. paratyphi.
B. Spread by fecal-oral route.
C. Incubation period between 3 to 21 days.
D. Osteomyelitis is one of the complications.
E. 1% becomes chronic carriers.
9. Cryptococcus neoformans
A. Caused meningitis.
B. Common found in immunocompromised patients.
C. Cryptococcus meningitis is not contraindications in lumbar puncture.
D. Indian ink staining is confirmation test.
E. Treated with Amphotericin B.
Answers
1. Regarding Malaria
A) T ( cdc.gov/malaria/about/biology)
B) F – by females Anopheles mosquitoes ( cdc.gov/malaria/about/biology)
C) F – it is highly effective against erythrocytic form s of P.vivax, P.ovale and P.malariae,
sensitive strains of P.falciparum and gametocytes of P.vivax.
( malariasite.com/malaria/chloquine)
D) F – Chloroquine is the first choice for all cases. Quinine is only for resistant P.falciparum.
(malaria site.com/malaria/antimalarial)
E) T – peripheral smear examination for malarial parasite is the gold standard in confirming
diagnosis. ( malariasite.com/malaria/staining_techniques)
2. Congenital Toxoplasmosis
A. F: about 1/3 of women who acquire infection with T. Gondi during pregnancy transmit
the parasite to the fetus (Harisson’s Principle of Internal Medicine, 16th Edition, pg
1243-1244)
B. F: If the mother being infected during 1st trimester, the incidence of transplacental
transmission is 15% and if mother being infected at 3rd trimester the incidence increase
to 65%. So (Harisson’s Principle of Internal Medicine, 16th Edition, pg 1244)
C. T: explanation sama dengan B
D. T: Clinical features of congenital toxoplasmosis: severe neurological complications
hydrocephalus, microcephaly, mental retardation, chorioretinitis. (Harisson’s Principle
of Internal Medicine, 16th Edition, pg 1245)

3. E. T: Many infant remain asymptomatic during birth because diagnosis if difficult to make.
(Harisson’s Principle of Internal Medicine, 16th Edition, pg 1244-1245)
3. Lymphatic filiariasis
A) True
B) True
Berdasarkan keterangan di atas maka, jawapan A-true dan jawapan B-true.
(KUMAR AND CLARK, CLINICAL MEDICINE 7E, PAGE 163-164,
http://www.itg.be/itg/distancelearning/lecturenotesvandenendene/41_Filariasisp3.htm
C) True
Based on the life cycle, adult worms will give rise to microfilariae. Maka jawapan C –true.
(www.cdc.gov)
D) True - Chronic hypereosinophilia can cause cardiac lesions such as or fibroplastic
endocarditis. The contents of the eosinophilic granules (including major basic protein) are toxic
to the endocardium and the adjacent myocardium. A restrictive cardiomyopathy can follow.
http://www.itg.be
E)True - TPE ni common kat india, southeast asia. Pulmonary symptoms are predominant:
cough, dyspnoea, "asthmatic syndrome". Chest X-rays very consistently show patchy infiltrates.
Sometimes the lymph nodes swell and splenomegaly occurs. The erythrocyte sedimentation
rate increases and there is marked eosinophilia. There are no microfilariae in the peripheral
blood. Serological tests for filariae are strongly positive. This condition responds very well to
therapy with DEC (diethylcarbamazine)
Pathophysio die, Migrating parasites traversing the lungs may cause bronchospasm, dyspnea,
and pulmonary infiltrates. Embolization of microfilariae or eggs, which degenerate and expose
antigens to the local immune system, leads to granuloma formation. Local elaboration of
chemokines and cytokines plays a role in T-cell recruitment and granuloma formation. Persistent
inflammation may lead to parenchymal necrosis and fibrosis.

4. It could be an acute setting because the symptoms are mainly pulmonary and may mimics
bronchial asthma.
http://emedicine.medscape.com/article/301070-overview#showall
www.itg.be
4. HIV
A. F- kerna mengikut WHO clinical staging, ade 4 iaitu:asymptomatic, mild symptoms,advanced
symptoms dan severe symptoms
B. F- sah2 false
C. T- mengikut UNICEF report terkini, IVDU memegang 57% takhta penyebab HIV.
D. T- kerna PCP hanya berlaku bila CD4 count less than 200X 100kuase6 / L.
E. T - http://www.ucsfhealth.org/conditions/aids/diagnosis.html
5. Clinical stages of HIV
a) FALSE.
Persistent Generalized Lymphadenopathy(PGL) is not present at inguinal lymph node,
becoz it is defined as nodes more than 1cm diameter, at two or more extrainguinal site,
persisting for 3 months or longer.
(Ref: OHCM 7th edition ,page 396)
b) TRUE
By definition, angular chelitis/stomatitis is inflamed painful cracking of the skin at mouth
corner due to iron deficiency, excess saliva or poorly fitting dentures.
(Ref: Macleod’s Clinical Examination 12th edition,page 350)
c) TRUE
Based on WHO clinical staging of HIV disease in adults and adolescents (2006 revision),
oral hairy leukoplakia is included in clinical symptom of stage 3.
(Ref: http://www.avert.org/stages-hiv-aids.htm)
d) TRUE
Additional findings in children with severe pneumocystis pneumonia include cyanosis,
nasal flaring, and intercostal retractions.
(Ref: http://emedicine.medscape.com/article/225976-overview#aw2aab6b7)
e) TRUE
http://www.nlm.nih.gov/medlineplus/ency/article/001448.htm
6. Opportunistic infection
A) T- Treatment is with oral azole drug. Where azole-resistant candida is present, caspofungin
or amphociterin can be use.
From Davidson page 386
B) T- it caused by Cryptococcus Neoformans when CD4 count < 50cells/mm3.
From Davidson page 394
C) F- treatment of choice for toxoplasmosis are the combination of sulphadiazine 4-6g/ day and
pyrimathamine 50-100mg a day. Both are by oral in divided doses with folinic acid 15 mg daily.

5. Alternatively, clarithromycin 2g per day can be given or atovaquonene 750 mg 4x/day per oral
with pyrimethamine 50-100mg/day per oral.
From ABC of AIDS page 48
D) F- AIDS is defined as development of specified opportunistic infections, tumor or else. So,
both AIDS and opportunistic infections occur when CD4 count< 200cells/mm3
From Davidson page 384
E) T - it caused by Penicillium marneffei when CD4 count < 50 cells/mm3. The fungus is sensitive
to amphotericin B, itraconazole, and ketoconazole
From http://www.cdc.gov/ncidod/eid/vol7no3_supp/sirisanthana.htm
7. Sexual transmitted diseases
F. Neisseria gonorrhoea is intracellular organism.
Ans = True
Reference – harrisons’ Volume I page 824 “smear of gonococcal reveals gram negative
intracellular diplococcic”
G. Urethral pus present in male with gonorrhoea infections.
Ans = True
Reference – harrisons’ volume I page 916
Gonorrhea infection in male can cause urethritis & major symptoms include are urethral
discharge + dysuria w/o urinary frequency or urgency.
H. ‘Clue cells’ seen in gonorrhoea.
Ans = False
Reference = Harrison’s page 827 & table 124-5 page 826 + wikipedia
Clue cells are epithelial cells of the vagina (squamous) that get their distinctive stippled
appearance by being covered with bacteria (coccobacilli). It is sign of bacterial vaginosis
cause by gardnerella vaginosis.
I. White curds can be present in bacterial vaginosis.
Ans = True
Reference = http://www.womanshealthvibe.com/bacterial-vaginosis/
Maksud Curd – coagulated acidic milk product made into cheese
In Bacterial vaginosis - Discharge is different in appearance and smell to a yeast
infection. Where as thrush usually causes thick white curd like discharge bacterial
vaginosis cause it to be grey in colour and very foul smelling.
J. Painless ulcer present in syphilis.
Ans = True
Reference = harrisons Volume I page325
Characteristis of syphilis = chancre (painless ulcer)
8. Typhoid fever
A. FALSE - “Typhoid caused by Salmonella typhi, S.paratyphi cause paratyphoid”
-Kumar & Clark pg.85-
B. TRUE - “S.typhi transmitted in contaminated food or water”

6. -Kumar & Clark pg.85 and OHCM pg.414-
C. TRUE - “The incubation period is 3-21 days.” -OHCM pg.414-
D. TRUE - “Usually in 3rd week of illness (without treatment) can lead to
complications; meningitis, lobar pneumonia, osteomyelitis, intestinal
perforation and hemorrhage.” -Kumar & Clark pg.85-
E. TRUE - “Between 1% and 4% will continue to carry the organism for more than
a year: this is chronic carriage” -Kumar & Clark pg.85
9. Cryptococcus neoformans
A) T – the infection range from harmless colonization of airway and asymptomatic infection to
meningitis and disseminated diseases (emedicine.medscape.com – cryptococcosis)
B) T - http://emedicine.medscape.com/article/215354-overview
C) T –For any patient who are suspected to have meningitis, it is important to perform a LP
(nlm.nih.gov -meningitis cryptococcal)
D)T – An India ink preparation is commonly used with CSF to identify organisms and support the
presumptive diagnosis (emedicine.medscape.com - crptococcosis Lab studies)
E) T – All type of cyptococcal infection treated initially with amphotericin B.
(emedicine.medscape.com. cryptococcosis treatment and management)
10. Below is true regarding skin lesions terminology
a. True - Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.;
Suurmond, Dick; Richard Suurmond (2005). Fitzpatrick's color atlas and synopsis of clinical
dermatology. New York: McGraw-Hill Medical Pub. Division
b. FALSE: vesicle is <0.5mm
c. TRUE
d. FALSE – The above is definition of excoriation. Lichenification is chronic thickening of
skin with increased skin markings, result of rubbing/scratching
http://www.avreskincare.com/misc/about_skincare/about_skin.html
e. FALSE: scale is palpable flakes. Yang thickened horny die cakap tu referring to Horn.
11. All are true regarding side effect of topical steroids on the skin
Side effects of tropical steroids:
1. Internal Cushing’s Syndrome (>500g hydrocortisone in one week)
2. Skin side effects skin atrophy, stretch mark (striae), easy bruising, perioral dermatitis,
enlarged blood vessel (telangiectasia), allergic reactions, increased susceptibility to skin
infection (http://www.dermnetnz.org/treatments/topical-steroids.html, 24th April 2011,
4.53pm)
A. T
B. T
C. T
D. T
E. F