Neurology



Infections

Section 1

1) Which of the following is a DNA virus?

a) hepatitis A virus

b) hepatitis B virus

c) hepatitis C virus

d) hepatitis D virus

e) hepatitis E virus

2) In hepatitis B infection:

a) 60-65% of acute cases are subclinical

b) 20% of acute cases become “healthy” carriers

c) 20% of cases developing cirrhosis will then progress to hepatocellular carcinoma

d) 10% of acute cases with “subclinical” disease will progress to a carrier state

e) 40% of acute infections will cause acute hepatitis

3) In hepatitis C infection:

a) 50% of acute infections will cause acute hepatitis

b) 25% of those developing cirrhosis will progress to hepatocellular carcinoma

c) 25% of cases developing chronic hepatitis will progress to cirrhosis

d) 50% of acute infections will produce a chronic hepatitis

e) 10% of acute infections causing “subclinical” disease will progress to a chronic hepatitis

4) All of the following tissues are resistant to tuberculosis infection EXCEPT:

a) the heart

b) the striated muscle

c) the thyroid

d) the adrenal gland

e) the pancreas

5) In which area is HIV-2 the predominant cause of AIDS?

a) West Africa

b) Central Africa

c) United States of America

d) Europe

e) Philippines

6) In which cell type does HIV infection in the central nervous system predominate?

a) oligodenrocytes

b) astrocytes

c) microglial cells

d) neurons of the cerebral cortex

e) neurons of the basal ganglia

7) The onset of AIDS in an HIV-infected patient is characterised by:

a) 80% of CD4+ T cells in the peripheral pool showing signs of HIV infection

b) extensive viral replication and lysis of macrophages

c) a CD4+ T cell count of < 500 cells/μL

d) a CD4:CD8 ratio of 1.0

e) a plasma viraemia titre of >1:32

8) Concerning bacterial structure:

a) gram positive and gram negative bacteria share structurally similar adhesin molecule

b) E. coli toxic production depends upon coordinated expression of adhesin proteins

c) a single bacterial species will not exhibit both pili and non pilar adhesin molecules

d) bacterial endotoxins are usually simple lipopolysaccharides

e) bacterial exotoxins act almost exclusively to lyse host cells by altering membrane permeability

9) Staphylococcus aureus:

a) are motile cocci

b) are gram negative organisms

c) does not cause impetigo

d) is the commonest pathogen in hospital acquired infections

e) virulence factors are predominantly plasmid mediated

10) Streptococci species causing scarlet fever are Lancefield group:

a) A

b) B

c) C

d) D

e) E

11) In clostridial infections:

a) botulinum neurotoxin is actively secreted by pathogenic clostridial botulinum

b) clostridial perfringens infection is rarely caused by biliary surgery

c) “gas gangrene” is marked by a profuse neutrophil infiltrate

d) tetanus toxin causes inhibition of inhibitory interneurons leading to spasms

e) clostridial difficile is unique, as it does not secrete toxins but is directly cytopathic

12) All of the following are paramyxoviruses EXCEPT:

a) the measles virus

b) the para influenzae virus

c) the rubella virus

d) RSV

e) the mumps virus

13) Lancefield group B streptococci characteristically cause:

a) urinary tract infections

b) pharyngitis

c) scarlet fever

d) rheumatic fever

e) impetigo

14) Bacteria:

a) are eukaryocytes

b) have nuclei

c) cannot synthesise their own DNA

d) can have two phospholipids bilayers

e) in the GIT are predominantly aerobic

15) Clostridium perfringens infection typically causes which of the following?

a) suppurative inflammation

b) granulomatous inflammation

c) cytopathic inflammation

d) necrotising inflammation

e) chronic inflammation

16) Streptococci do NOT:

a) stain gram positive

b) cause suppurative wound infections

c) form grape-like clusters

d) cause rheumatic fever

e) secrete exotoxin

17) Regarding clostridia:

a) clostridia tetani releases a neurotoxin that blocks synaptic acetylcholine release

b) clostridia welchii causes anaerobic cellulitis

c) clostridia botulinum releases tetanospasmin

d) clostridia perfringens does not release any neurotoxins

e) clostridia perfringens grows in inadequately sterilised canned foods

18) Which of the following statements regarding tuberculosis are NOT true?

a) mycoplasma area aerobic non spore-forming bacilli

b) mycoplasma tuberculosis has not endotoxins nor exotoxins

c) ghon complexes are residual from primary infection

d) caseous necrosis is characteristic

e) Mantoux testing is an example of a type III immune complex hypersensitivity reaction

19) With respect to viral hepatitis:

a) hepatitis C is transmitted by faecal - oral route

b) hepatitis D is commonly found to coexist in hepatitis B positive people

c) hepatitis A is transmitted by blood–born means

d) hepatitis B E Ag indicates infectivity

e) hepatitis B S Ag indicates prior vaccination

20) HIV infection:

a) is caused by rhino virus

b) results in increased CD4 and T cell memory

c) results in inversion of the CF4-CD8 ratio

d) increases immature precursors of CD4 and T cells

e) causes a CD4-CD8 ratio close to 2

21) A typical feature of AIDS:

a) decreased delayed type hypersensitivity reaction

b) lymphocytosis

c) hypogammaglobulinaemia

d) increased CD4 and T cells

e) increased chemotaxis and phagocytosis

22) Mumps virus is a:

a) adenovirus

b) herpes virus

c) paramyxovirus

d) pox virus

e) picornavirus

23) All of the following organisms cause a clinical effect via the production of an exotoxin EXCEPT:

a) clostridium tetani

b) staphylococcus aureus

c) E. coli

d) pseudomonas aeruginosa

e) vibrio cholera

24) A 34 year old HIV positive man presents with headache and fever. A cerebral CT scan shows a 3cm diameter mass lesion in the left cerebral hemisphere. Which pathogen is MOST likely to be responsible for this lesion?

a) mycobacterium tuberculosis

b) atypical mycobacteria

c) toxoplasma

d) cryptococcus

e) staph aureus

25) In viral hepatitis:

a) the majority of cases of acute hepatitis B infection result in a carrier state, without clinical evidence of disease

b) anti HBs appear in the first week of infection

c) anti HCV IgG does not confer immunity to hepatitis C

d) the major cause of death from hepatitis B is hepatocellular carcinoma

e) hepatitis A virus has an outer surface envelope of protein, lipid and carbohydrate

26) Mycobacterium tuberculosis owes its pathogenicity in part to:

a) exotoxins

b) histolytic enzymes

c) cell wall sulfatides

d) endotoxins

e) the nutritional status of the host

27) The following enteritis may frequently be carried by domestic dogs:

a) shigella

b) salmonella

c) cholera

d) campylobacter

e) yersinia enteritis

28) The following is transmitted by droplet inhalation:

a) rocky mountain spotty fever

b) scrub typhus

c) epidemic typhus

d) Q fever

e) rickettsial pox

29) With regard to infectious mononucleosis, which is INCORRECT?

a) IgG antibodies against EBV persist for life

b) IgA Abs prevent infection of B cells, but increase infectivity for epithelial cells

c) cytotoxic CD8+ T cells and NK cells are needed in controlling B cell proliferation

d) latent EBV remains in some B cells and some epithelial cells

e) raised circulating monocyte levels assist in its diagnosis

30) Which of the following is NOT true with respect to N. gonorrhoea?

a) it is a gram negative diplococcus

b) capsular polysaccharides inhibit the antibody response

c) it induces the production of tumour necrosis factor α in infected cells

d) pathogenic Neisseria bind avidly to IgE

e) it may cause pharyngitis

31) Which of the following is NOT due to infection with clostridium species bacteria?

a) pseudo membranous colitis

b) botulism

c) Lyme disease

d) tetanus

e) gangrene

32) Which of the following is the most common cause of childhood diarrhoea in Australia?

a) yersinia enterocolitica

b) rotavirus

c) Giardia lamblia

d) E. coli

e) campylobacter jejuni

33) Which is transmitted mainly by inhalation of dust from pigeon droppings?

a) chlamydia trachomatis

b) mycobacterium avium-intracellulare

c) Legionella pneumophila

d) Cryptococcus neoformans

e) Aspergillus species

34) Which of the following diseases is NOT caused largely by toxin production?

a) whooping cough

b) tetanus

c) cholera

d) giardiasis

e) scalded skin syndrome

35) What is the major cause of the common cold?

a) adenovirus

b) influenza virus

c) coxsackie virus

d) rhino virus

e) none of these

36) With regard to malaria, which is INCORRECT?

a) sporozoites invade hepatocytes

b) hepatocyte rupturing releases thousands of merozoites

c) chloroquine inhibits heme polymerase

d) merozoites bind RBCs and infect them where they mature

e) mature merozoites infect mosquitoes to continue the cycle

37) Regarding tetanus toxin, which is CORRECT?

a) it reaches the CNS via the blood stream

b) it acts at the neuromuscular junction

c) it blocks secretion of inhibitory neurotransmitters

d) it acts by inhibiting protein synthesis

e) it causes demyelination of nerves

38) With regard to leprosy, which is INCORRECT?

a) presence of CD4+ T cell-mediated response results in tuberculoid type

b) lepromatous type occurs in anergic patients with CD8+ suppressor cells dominating

c) antibody production is impaired in lepromatous leprosy

d) type IV HS reactions result in the granulomatous lesions of tuberculoid leprosy

e) patients with lepromatous leprosy have nodular lesions and are more infectious

39) Which of the following is NOT gram positive species of bacteria?

a) bacillus

b) clostridium

c) listeria

d) neisseria

e) lactobacilli

40) Which is the major cause of croup?

a) adenovirus

b) influenza virus

c) coxsackie virus

d) rhino virus

e) none of these

41) Which of the following is an obligate anaerobe?

a) pseudomonas

b) bacillus

c) bacteroides

d) E. coli

e) neisseria

The following statements (a) to (e) relate to Question 42 to Question 46:

A E.coli

B proteus mirabilis

C pseudomonas aeruginosa

D all of the above

E none of the above

42) Which micro-organism is a source of endotoxin?

43) Which micro-organism grows best in aerobic conditions?

44) Which micro-organism does not cause infections enterocolitis?

45) Which micro-organism is a cause of UTI?

46) Which micro-organism is not associated with suppurative infections of the abdominal cavity?

47) With regard to the parasitic metazoan (helminths), which is INCORRECT?

a) trematodes are flukes

b) cestodes are tapeworms

c) nematodes are roundworms

d) echinococcus is a trematode that causes hydatid cysts

e) taenia solium is ingested in rare pork

48) With regard to staphylococcus aureus, which is INCORRECT?

a) it is catalase positive

b) it differs from micrococcus in that it is fermentative

c) it differs from other staph. in that it is coagulase positive

d) in humans, it resides mainly on skin

e) it is subgrouped by phage typing

49) With regard to streptococci, which is INCORRECT?

a) viridans streptococci are α-haemolytic

b) streptococci faecalis is α-haemolytic

c) streptococci pneumoniae is α-haemolytic

d) streptococci pyogenes is GpA β-haemolytic streptococci

e) rheumatic fever is caused by streptococci pyogenes infections

50) Campylobacter species induce enteric disease by all the following mechanisms EXCEPT:

a) toxin induced disease similar to that of cholera

b) invasion and proliferation within the intestinal epithelium

c) a shigella-like dysentery

d) translocation to the intestinal lamina propria and mesenteric lymph nodes

e) induction of granuloma formation

51) Which of the following is NOT a pyogenic coccus?

a) pseudomonas aeruginosa

b) staphylococcus epidermidis

c) streptococcus pyogenes

d) streptococcus pneumoniae

e) neisseria meningitides

52) Which, if any, of the following are facultative intracellular parasites of macrophages?

a) L. pneumophilia and M. tuberculosis

b) M. tuberculosis and C. trachomatis

c) Epstein Barr virus and cytomegalovirus

d) M. pneumonia and C. trachomatis

e) none of the above combinations

53) Which of the following is NOT a member of the Herpes family of viruses?

a) herpes simplex

b) varicella-zoster

c) cytomegalovirus

d) Epstein-Barr virus

e) none – all of the above belong to the herpes family

54) Streptococcus pneumoniae uses all the following mechanisms to escape the immune system EXCEPT:

a) carbohydrate capsule which inhibits phagocytosis or the organism

b) use of pili (fimbriae)

c) secretion of proteases that degrade antibodies

d) surface lipoteichoic acid which binds to host extracellular matrix

e) M-protein on the surface which prevents the organism from being phagocytosed

55) Which of the following is NOT a member of the Paramyxo family of viruses?

a) parainfluenza

b) respiratory syncytial virus

c) rubella virus

d) measles virus

e) mumps virus

56) Coxsackie viruses cause all EXCEPT for:

a) hand, foot and mouth disease

b) herpangina

c) pleurodynia

d) erythema infectiosum

e) myocarditis

57) Which of these is associated with the Guillain-Barre syndrome:

a) adenovirus

b) influenza virus

c) coxsackie virus

d) rhino virus

e) none of these

Infections – Answers

1. B

2. A

3. D

4. D

5. A

6. C

7. E

8. B

9. E

10. A

11. D

12. C

13. A

14. D

15. D

16. C

17. B

18. E

19. D

20. C

21. A

22. C

23. D

24. C

25. C

26. C

27. D

28. D

29. E

30. D

31. C

32. B

33. D

34. D

35. D

36. E

37. C

38. C

39. D

40. E

41. C

42. D

43. C

44. B

45. D

46. D

47. D

48. D

49. B

50. E

51. A

52. A

53. E

54. B

55. C

56. D

57. C

Section 2

Infection and Environment

1) Which is TRUE for radiation injury?

a) hyperbaric oxygen protects against radiation injury

b) median lethal dose of total body irradiation is 25-40 Gy

c) ionising radiation exposure increases proto-oncogenes expression, decreases production of tumour necrosis factor, and decreases production of manganese superoxide dismutase

d) ionising radiation increases the rate of chronic lymphocytic leukaemia

e) most cancers induced by ionising radiation have occurred at doses greater than 0.5 Gy

2) For obesity, which is NOT TRUE?

a) approximately 25% of Americans are obese

b) a body mass index of 25kg/m2 is normal

c) leptin acts as an anti-obesity factor

d) obesity is associated with hyperinsulinaemia

e) normotensive obese people are at increased risk of stroke

3) For viral respiratory infections, which is TRUE?

a) coronaviruses are the most common cause of the common cold

b) rhinoviruses grow best at 33-35C

c) influenza virus C infects humans, horses, pigs and birds and is the leading cause of pandemics

d) viral induced tonsillitis is uncommon in children

e) rotavirus is a frequent cause of lower respiratory tract infections in infants

4) For mycobacterium, which is TRUE?

a) M. avium, M intracellulare, and M. bovis have no virulence in normal hosts

b) type II hypersensitivity to tubercle bacillus leads to resistance to the organism

c) T cell mediated immunity is demonstrable by a positive purified protein derivative test reaction

d) granulomas of secondary tuberculosis that occur in the lung apex are known as Ghon complexes

e) miliary tuberculosis refers to haematogenous dissemination of tuberculous lesions throughout the body especially to the heart, striate muscles, thyroid, and pancreas

5) For syphilis, which is TRUE?

a) the secondary stage is characterised by lesions of the aorta, heart, and central nervous system

b) the hallmark of syphilis is an obliterative endarteritis and plasma-cell mononuclear infiltrate

c) a primary syphilis lesion is a painful, raise, red lesion known as a chancre

d) the classic triad of congenital syphilis is a keratitis, saddle nose deformity and deafness

e) congenital syphilis is more severe the younger the foetus is

6) Which is a TRUE post bacterial sequelae?

a) shigella may lead to Reiters syndrome in HLA-DR4 patients

b) campylobacter may lead to Guillain-Barre in HLA-B27 patients

c) yersinia in a chronic carrier state may lead to cholelithiasis

d) salmonella infection may result in erythema nodosum

e) gonorrhoea may lead to an immune-complex glomerulonephritis

7) For bacterial respiratory infections, which is NOT TRUE?

a) haemophilus influenzae type B is the most common type to cause severe disease

b) mycobacterium tuberculosis is the single most important infectious cause of death worldwide

c) bordetella pertusis colonises the brush border of bronchial epithelium and invades macrophages

d) DPT vaccine prevents corynebacterium diphtheriae infection

e) most patients with cystic fibrosis die due to pseudomonas aeruginosa infection

8) For vector born infections, which is TRUE?

a) hosts previously unexposed to Dengue are susceptible to haemorrhagic dengue fever

b) rickettsiae are obligate intracellular protozoan parasites that cause epidemic typhus

c) yersinia pestis is a gram-negative facultative intracellular bacterium that is transmitted to humans by rats

d) duffy antigen positive red blood cells are resistant to plasmodium vivax

e) 5% of hosts infected with schistosomes develop severe portal hypertension

9) For vitamin deficiencies, which is TRUE?

a) niacin deficiency results in pellagra-dementia, dermatitis, and diarrhoea

b) vitamin D deficiency in adults results in rickets

c) folic acid deficiency results in bleeding diathesis

d) vitamin B2 deficiency results in Korsakoff syndrome

e) pantothenic acid deficiency results in megaloblastic anaemia and neural tube defects

10) For oral contraceptives, which is TRUE?

a) oral contraceptive therapy increases the risk of endometrial carcinoma tenfold after ten years use

b) nulliparous women younger than 25 on the pill have an increased risk of breast cancer

c) the longer the use, the greater the risk of ovarian carcinoma

d) young women smokers, who use the pill, are 10 times less likely to suffer a myocardial infarct than non-pill users

e) there is a slight increased risk of hepatic carcinoma especially in older women who have used the pill for a prolonged period

Section 2

Answers

1. E

2. E

3. B

4. C

5. B

6. B

7. D

8. E

9. A

10. B

Section 3

Infectious Disease

1) Which association is INCORRECT?

a) HHV-8 and Kaposi sarcoma

b) helicobacter pylon and chronic gastritis

c) Escherichia coli and haemolytic-uremic syndrome

d) Bartonella henselae and lyme disease

e) cryptosporidium parvum and chronic diarrhoea

2) What are the smallest free-living organisms known?

a) chlamydiae

b) rickettsiae

c) mycoplasma

d) viruses

e) spirochetes

3) Which is the most common cause for the common cold?

a) influenza virus

b) parainfluenza virus

c) respiratory syncytial virus

d) adenovirus

e) rhinovirus

4) Cytomegalovirus:

a) is an α-group herpes virus

b) infects white blood cells of the immunocompromised

c) can be transmitted in organ transplants

d) is usually accompanied by candidiasis in AIDS

e) 90% of CMV-infected neonates suffer full-blown congenital CMV infection, resembling erythroblastosis foetalis

5) Regarding tuberculosis:

a) the Ghon complex is part of the secondary infection

b) primary granulomas mostly occur at lung apices

c) mycobacteria are aerobic spore-forming mobile bacilli

d) M. avium and M. intracellulare cause disseminated infection in AIDS patients

e) mycobacteria grow faster than other bacteria

6) Which organ is relatively resistant to tuberculosis infection?

a) thyroid

b) bone marrow

c) adrenals

d) epididymis

e) meninges

7) Which bacterial infection is Guillain-Barre syndrome associated with?

a) salmonella

b) shigella

c) gonorrhoea

d) yersinia

e) campylobacter

8) Which is NOT a feature of neisseria gonorrhoea?

a) diplococcus

b) flagellated

c) encapsulated

d) gram negative

e) pyogenic

9) Which is NOT a feature of streptococcus?

a) gram positive cocci

b) aerobic

c) most are β-haemolytic

d) minimal destruction of host tissues

e) grow in pairs or chains

10) Streptococcus pyogenes is typed as:

a) α -haemolytic

b) β-haemolytic Lancefield group A

c) β haemolytic Lancefied group B

d) β-haemolytic Lancefield group C

e) β-haemolytic Lancefield group D

11) Which bacterial infection produces lymphocytosis?

a) clostridium perfringens

b) neisseria gonorrhoeae

c) bordetella pertussis

d) haemophilus influenzae

e) Epstein-Barr virus

12) Which microbe does not produce exotoxins?

a) bordetella pertussis

b) clostridium difficle

c) staphylococcus aureus

d) bacteroides fragilis

e) corynebacterium diphtheriae

13) Which is the most common cause of hospital acquired infection?

a) pseudomonas aeruginosa

b) Escherichia coli

c) staphylococcus aureus

d) campylobacter jejuni

e) neisseria gonorrhoeae

14) Legionella pneumophilia infects:

a) macrophages

b) neutrophils

c) T-lymphocytes

d) B-lymphocytes

e) eosinophils

15) Regarding candidiasis:

a) candida species are not part of the normal flora of the body

b) severe invasive candidiasis commonly involves the kidney

c) candida exists in yeast form, not hyphal form

d) candida does not invade the blood stream

e) candida grows best in warm dry environments

16) Cryptococcus neoformans causes:

a) oesophagitis

b) pneumonia

c) thrush

d) amnionitis

e) meningoencephalitis

17) Aspergillus:

a) causes distiller’s lung

b) causes serious pneumonia in healthy people

c) produces allergic alveolitis by inducing type II and type IV hypersensitivity reactions

d) may cause chronic obstructive lung disease

e) does not secrete exotoxins

18) Regarding mycoplasmas:

a) obligate intracellular parasites

b) lack ATP synthesis

c) have a cell wall

d) ureaplasmas cause nongonococcal urethritis

e) mycoplasma pneumoniae spreads by faecal-oral transmission

19) Which diarrhoeal illness is associated with steatorrhoea:

a) giardia lamblia

b) entamoeba histolytica

c) salmonella enteritidis

d) rotavirus

e) campylobacter jejuni

20) Giardia lamblia:

a) causes dysentery

b) cysts are killed by chlorine

c) ferments glucose

d) are not flagellated

e) IgA provides life-long immunity

21) Regarding protozoal infections:

a) toxoplasma can only reproduce in the intestinal epithelium of the cat

b) cryptospordia cause chronic debilitating diarrhoea in normal children

c) trichomonas exists in cyst and trophozoite forms

d) plasmodium malaride is the major parasitic cause of death worldwide

e) schistosoma mansoui is the protozoal schistosoma with highest mortality rates

22) Which is not a typical feature of plasmodium falciparum infection?

a) cerebral symptoms

b) renal failure

c) pulmonary oedema

d) mild anaemia

e) death

23) Regarding plasmodium protozoan parasites:

a) sporozoites infect mosquitoes

b) gametocytes infect red blood cells

c) merozoites are released from ruptured hepatocytes

d) sporozoites are released from ruptured red blood cells

e) merozoites infect hepatocytes

24) Schistosomiasis:

a) is caused by a spirochete

b) is transmitted by freshwater worms

c) infect humans by the faecal-oral route

d) schistosomes mature in the portal venous system

e) has an association with lymphocytosis

25) Which infection is the most common cause of Waterhouse Friderichsen syndrome?

a) streptococcus pyogenes

b) mycoplasma pneumoniae

c) neisseria meningitides

d) mycobacterium tuberculosis

e) cytomegalovirus

26) Which is not due to coxsackie virus infection?

a) mylocarditis

b) herpangina

c) hand, foot and mouth disease

d) pleuritis

e) enterocolitis

27) Staphylococcus aureus:

a) is coagulase negative

b) causes scarlet fever

c) more commonly causes lymphangitis than streptococcus

d) is the second most common cause of skin abscesses

e) is catalase positive

28) Which is a gram negative anaerobe?

a) bacteroides fragilis

b) Escherichia coli

c) pseudomonas aeruginosa

d) clostridium difficle

e) bacillus anthracis

29) What causes the rash in measles infection?

a) direct cellular injury

b) secondary infection

c) immunoglobulin secretion (B cell immunity)

d) T cell mediated immunity

e) inhibition of protein synthesis

30) Which is NOT a post-streptococcal syndrome?

a) glomerulonephritis

b) scarlet fever

c) rheumatic fever

d) erythema nodosum

e) arthritis

31) Which doesn’t infect macrophages?

a) bordetella pertussis

b) mycobacterium tuberculosis

c) mycobacterium leprae

d) legionella pneumophilia

e) HIV

f) none of the above

Section 3

Infectious Disease – Answers

1. D

2. C

3. E

4. C

5. D

6. A

7. E

8. B

9. B

10. B

11. C

12. D

13. C

14. A

15. B

16. E

17. D

18. D

19. A

20. C

21. A

22. D

23. C

24. D

25. C

26. E

27. E

28. A

29. D

30. B

31. F

Section 4

Environmental

1) Which is a cilia toxin in tobacco?

a) nitrogen dioxide

b) carbon monoxide

c) phenol

d) nicotine

e) nickel

2) Which are the most potent chemical carcinogens?

a) volatile organic compounds

b) lead

c) solvents

d) rubber products

e) aromatic halogenated compounds

3) Which is NOT a feature of lead toxicity?

a) renal toxicity

b) anaemia

c) lung fibrosis

d) insomnia, fatigue

e) peripheral neuropathy

4) Regarding lead poisoning:

a) lead is absorbed through the skin

b) lead absorption is greatest in adults

c) there is a macrocytic normochromic anaemia

d) lead readily crosses the placenta

e) lead deposited in bones has a half-life of 3 years

5) Organochlorines, such as DDT, persist in:

a) bones

b) fat tissue

c) peripheral nerves

d) bone marrow

e) kidney

6) In hyperthermia:

a) core body temperature is not maintained in heat exhaustion

b) heat cramps arise due to water depletion

c) in heat stroke, there is profound peripheral vasoconstriction

d) atrial fibrillation is the most common arrhythmia

e) muscle necrosis may occur

7) Regarding lead, which is TRUE?

a) adults absorb lead more easily than infants and children

b) the half-life of lead in bone is three years

c) most of absorbed lead ends up in soft tissues

d) lead is rapidly cleared from the blood stream

e) in lead poisoning, you may see radio dense deposits in metaphysis of bones in children

8) Regarding radiation, which is TRUE?

a) UV radiation is a type of ionising electromagnetic radiation

b) cells in B2 and mitotic phases of cell cycle are most sensitive to ionising radiation

c) UVB has a wavelength range of 400-600nm

d) particulate ionising radiation of alpha particle kind consists of electrons

e) alpha particles have high tissue penetration

9) Regarding influenza virus, which is FALSE?

a) is a single stranded RNA virus

b) clearance of primary influenza infection is by cytotoxic T cells and macrophages

c) influenza pandemics are caused by antigenic drift

d) antibodies to haemagglutinins and neurominidases antigens on lipid bilayer of influenza envelope confers immunity to re-infection

e) influenza types B and C commonly cause respiratory infections in children and do not show antigenic shift or drift

10) Mycoplasma tuberculum – which is TRUE?

a) is an anaerobic non motile acid-fast bacilli

b) the Ghon complex consists of an apical parenchymal lesion and enlarged nodes drain the primary focus

c) Pott’s disease is Tb of the kidney

d) T lymphocyte mediated response controls 95% of infections in AIDS cases

e) reactivation of latent lesions to secondary Tb occurs 5-10% of cases

11) Regarding gastrointestinal infections:

a) campylobacter infection may result in Guillain-Barre syndrome and Reiters syndrome in HLA-B27 positive individuals

b) “Typhoid Mary” probably had a chronic colonisation of her spleen, thus making her a carrier???????

c) vibrio cholerae invade the epithelium and causes these cells to express enterotoxins

d) entomoeba histolytic infection results in one or more hepatic abscesses in up to 40% of patients in amoebiasis

e) giardia lamblia are the most common cause worldwide of dysentery

12) The cytochrome P-450:

a) gene CYPIAI is induced by polycyclic chromatic hydrocarbons in cigarette smoke and is protective against lung cancer

b) isoelzymes are only expressed in the liver of normal persons

c) metabolises 2-napthylenine, an azo-synthetic dye component associated with increased rates of hepatocellular cancer

d) system is involved in the metabolisation of alcohol to acetaldehyde

e) all of the above are false

13) Regarding physical environmental injuries:

a) immersion blast injuries would not be expected to damage solid tissues

b) high altitude pulmonary oedema (HAPE) is caused by reduced barometric pressure

c) air-embolism is not a risk of free (non-SCUBA) depth diving

d) “the bends” is a painful symptom of aseptic necrosis of bone caused by ??????

e) window glass transmits UVA therefore allowing tanning

14) Smoking:

a) stroke is five times more common in cigarette smokers than in non-smokers

b) smoking induced emphysema begins to reverse within 1-2 years of cessation of smoking

c) maternal smoking has deleterious effects on foetal intellectual development

d) reduction in risk of MI after cessation of smoking approaches baseline in 5-20 years

e) 50% of bronchogenic carcinoma is attributable to cigarette smoking

15) All are common adverse drug reactions EXCEPT:

a) tinnitus and dizziness with salisylate

b) acute tubular necrosis with salisylate

c) dystonic reactions with phenothiazines

d) haemolytic anaemia with methyldopa

e) diffuse hepatocellular damage with hepothane

16) Poisons and drugs of abuse – all true EXCEPT:

a) wrist drop and foot drop may develop with peripheral neuropathy in lead poisoning

b) marijuana may be used in treating asthma

c) marijuana may reduce fertility in males

d) Weincke’s syndrome in chronic alcoholism is associated with thiamine deficiency

e) use of cocaine may precipitate rupture of the descending aorta

17) Radiation injury:

a) gamma rays are high velocity and more likely to produce a radiation effect than alpha rays

b) the radio sensitivity of cells is proportional to their level of spendlisation

c) well-oxygenated tissues are less prone to radiation damage

d) one hundred rads of whole-body radiation can cause significant systemic reactions

e) radiation with CNS effects, has approximately 50% of survival

18) Tumours:

a) haematomas are tumours of blood vessels

b) leucomyosarcomas arise from or resemble striated muscle cells

c) teratomas do not represent more than two germ cell layers

d) anaplasia is common in benign tumours

e) metastasis via haematogenous spread is typical of sarcomas

Section 4

Environmental – Answers

1. B

2. E

3. C

4. D

5. B

6. E

7. D

8. B

9. C

10. E

11. A

12. D

13. A

14. D

15. B

16. E

17. D

18. E

Section 5

Infectious Disease

1) With regards to tuberculosis, which is false?

a) drug mutations is caused by mutations in the RM polymerase and catalase (for rifampicin and isoniazid respectively)

b) mycobacterium tuberculosis infects about one fifth of the world’s population and kills around 3 million people per year

c) M. tuberculosis pathogenicity is related to its ability to escape killing by macrophages and induce delayed type hypersensitivity

d) after initial infection, it takes 2-3 weeks until development of cell mediated hypersensitivity

e) M. bevis is transmitted by milk from diseased cows

2) What is the second leading cause of diarrhoea among infants?

a) shigella dysenteriae

b) o-type enterotoxic E.coli

c) rotavirus

d) enteric adenoviruses

e) norwalk-like viruses

3) Syphilis – which is false?

a) in congenital syphilis, placental invasion by treponemes does not occur until 5th month gestation

b) the histological hallmarks are obliterative endarteritis and ??plasma cell rich mononuclear infiltration

c) the aorta is involved in 80% of tertiary syphilis cases

d) lack of antigens (proteins) within the outer membrane of the sprochaete allow it to be less affected by host cellular and humoral immune responses

e) Hutchinson teeth are commonly found in tertiary syphilis

4) EBV may cause all but which of the following symptoms and signs?

a) sore throat, fever, lymphadenitis

b) splenomegaly

c) hepatitis and a peripheral neuropathy

d) orchitis

e) afebrile rash resembling rubella

5) With respect to drugs of abuse:

a) pheneyclidine characteristically induces nystagmus

b) pisilocybin was once used as an anaesthetic

c) cocaine is classed as a narcotic and blocks uptake of noradrenaline and dopamine at the synapse

d) chronic marijuana smoking, like tobacco smoking, can increase the risk of lung cancers and cause lung damage

e) intravenous addicts have a higher risk of endocarditis, the common organism isolated being staph epidermidis

6) All but one of the following cytokines have been implicated in cancer cachexia or sepsis cachexia:

a) TnF α

b) IL-1

c) IL-2

d) IL-6

e) IFn δ

7) All but one of the following pathogens show significant antigenic variation:

a) rickettsia prowazekii

b) rhinoviruses

c) neisseria gonorrhoea

d) barrelia burgdorfei

e) giardia lamblia

8) Guillain-Barre syndrome is a complication of:

a) yersinia enterocolitia

b) campylobacter

c) shigella

d) viral gastroenteritis

e) cholera

9) Many cholera epidemics begin along the:

a) Thames River

b) Ganges River

c) Mississippi River

d) Avon River

e) Nile River

10) Silver stains identify:

a) pneumocystis

b) cryptococci

c) malaria

d) GNB

e) TB

11) Staphylococcal protein A:

a) is a pore forming protein that depolarizes cell neurons

b) is also secreted by streptococci

c) binds Fe portion of Ig

d) causes inhibition of SFN activated macrophages

e) is a detergent-like peptide

12) Chlamydiae differ from bacteria in that they:

a) lack a cell wall

b) are faultive intracellular pathogens ?????

c) lack ATP synthesis

d) cause STDs

e) are the tiniest free living organisms known

13) The infective organism of Kala-azar is:

a) Wuchereria bancrofti

b) Trypanosoma cruzi

c) Leishmania donovani

d) Babesia microti

e) Completae bastardo questioni

14) The reservoir hosts of Lyme disease:

a) field mice

b) humans

c) cows

d) mosquitoes

e) pet hamsters

15) Which of the following pathogens shows significant antigenic variation?

a) staphylococcus aureus

b) neisseria gonorrhoeae

c) H. influenzae

d) adenovirus

e) E.coli

16) Yersinia pestis causes which disease?

a) lyme disease

b) relapsing fever

c) rocky mountain spotted fever

d) dengue fever

e) bubonic plague

17) Regarding plasmodium falciparum infection:

a) it causes mild anaemia

b) does not cause cerebral malaria

c) merozoites are transmitted by mosquito bites

d) parasites change appearance from ring to schizont form inside RBCs

e) as hepatocytes rupture, they release approximately 300 merozoites into the circulation

18) In what city was the 1976 convention of the American Legion held, (the first named outbreak of Legionnaires disease)?

a) Pontiac

b) New York

c) Baltimore

d) Philadelphia

e) Green Bay

19) Which of the following organisms produces a toxin to cause diarrhoea?

a) shigella flexneeri

b) campylobacter jejuni

c) yersinia enteritis

d) salmonella typhi

e) Escherichia coli

20) The third leading cause of hospital acquired infections is:

a) Staph aureus

b) E. coli

c) P. aeruginosa

d) St. pneumoniae

e) H. influenzae

21) Members of the picornavirus family include all EXCEPT:

a) hepatitis A virus

b) measles virus

c) coxsackie virus B

d) polio virus

e) rhinovirus

22) The following are true about Haemophilus influenza EXCEPT:

a) H. influenzae causes meningitis, URTIs, pneumonia and endocarditis

b) H. influenzae causes various suppurative infections

c) it is the most common cause of meningitis in > 5 year olds

d) it is an encapsulated coccobacillary gram negative organisms

e) over 90% are encapsulated type is strains

23) Chlamydial organisms:

a) respond to penicillin

b) synthesize their own nucleic acids but not their own ATP

c) possess DNA not RNA

d) are extracellular organisms

e) all cause urethritis and cervicitis

24) The following about CMV are all true EXCEPT:

a) there are several serotypes

b) the infection is almost always latent or asymptomatic in adults unless the patient is immunocompromised or debilitated

c) it can be transmitted through breast milk

d) there are two peaks of contraction of CMV – in utero and after age 15

e) it can cause entercolitis secondary to ulcerative lesions in the intestine

25) Mumps:

a) is a togavirus

b) is bilateral (parotitis) in 50% of cases

c) orchitis occurs in 30% of cases

d) the vaccine is prepared from a cell-free toxin

e) can cause myocarditis, encephalitis and meningitis

26) Which are obligate intracellular organisms?

a) plasmids

b) bacteriophages

c) mycoplasma

d) RNA viruses

27) Mycoplasma differs from bacteria in that it:

a) lacks metabolic capacity

b) lacks a cell wall

c) is susceptible to antibiotics

d) have nuclei

28) Causes of bloody diarrhoea include all but:

a) staphylococci enterotoxins

b) salmonella

c) shigella

d) campylobacter

29) Which is most likely to cause systemic infection?

a) cholera

b) salmonella typhi

c) campylobacter

d) shigella

30) Which bacteria causes diarrhoea via production of an exotoxin?

a) staphylococci

b) shigella

c) toxigenic E. coli

d) campylobacter

31) Haemophilus influenzae:

a) vaccine is directed against cell wall proteins

b) type C is most commonly associated with severe invasive disease

c) unencapsulated form is responsible for about 50% of pharynx colonisation

d) can release a toxin to disrupt ciliary beating

32) Tertiary syphilis is evidenced in all of the following organs except:

a) external genitalia

b) liver

c) bones

d) aorta

33) The underlying histological abnormality in treponema pallidum infection is

a) granulomatous inflammation

b) toxin mediated

c) obliterative endarteritis

d) cytolysis of superficial epithelium

Section 5

Infectious Diseases – Answers

1. B

2. D

3. E

4. D

5. A

6. C

7. A

8. B

9. B

10. A

11. C

12. No answer

13. No answer

14. No answer

15. No answer

16. No answer

17. No answer

18. No answer

19. No answer

20. No answer

21. No answer

22. No answer

23. No answer

24. No answer

25. No answer

26. D

27. B

28. A

29. B

30. C

31. D

32. A

33. C

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